Florida SHOTS Health-Care Enrollment

Enroll online

Or you may download the forms below to be faxed to 850-922-4195.

Documents below open in new window

Adobe Acrobat documentAuthorized Private Provider User Agreement For Access to Florida SHOTS
(Form DH-1479)
Adobe Acrobat documentInstructions for form

Authorized Users:

Florida SHOTS requires that providers be licensed under chapters 458, 459, or 464 in the state of Florida. Credentials are verified before registry access is granted. Information is password-protected and stored on a secure server.