For US Healthcare Professionals
Register new patients and review patient status:

My QUTENZA Connect Practice Registration

Fill out the form to register your practice in the My QUTENZA Connect Savings Program.

To secure your privacy, this session will time out if left idle for 15 minutes. Information will not be saved and you will need to restart registration.


Auto populate form with NPI. (If NPI does not auto populate, please fill in the remaining fields.)

All fields marked with * are required




Once all the required fields are populated, click "Submit Registration." This will prompt the support team to contact your practice to confirm the information provided. To reach a support team member directly, call 855-802-8746.

By clicking on the "Submit Registration" button, you agree that the information you provide will be governed by our site Privacy Policy.

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QZA-09-22-0022 v3.0 August 2023