This form is to request an email change to an active PDMP account
PDMP Request for Email Change  

This form is to request an email change for a current active account.  If your role has changed you will need to apply for a new account through DHHS using the link below

Welcome to the NE PDMP Email Change Request Form.
Before beginning the registration process please be prepared with the following:
  • Professional license number
  • Unique email address - both old an new email address
  • Copy of state professional license, wallet card, or diploma (for non-Nebraska license holders only)
 
If you are having issues accessing your Nebraska PDMP account; do not submit a new request for access; instead please contact support at SUPPORT@CYNCHEALTH.ORG or 402-506-9900 option 1.

Out of State Attestation
By checking this box below, you attest that you have a treatment relationship with a Nebraska resident (Neb. Rev. Stat. § 71-2454) 2) and that your license is active and in good standing.

Please attach proof of license below.
Please mark the box that you agree
Please mark the box that you agree
File attachments associated with the ticket.
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Other Fields

Your name
Verification Code