Florida SHOTS™ Health-Care Enrollment
Interested in Administering Novel H1N1 Influenza Vaccine?
Visit our H1N1 enrollment page for details.
Enroll online
For enrollment, without joining the mass vaccination campaign for novel H1N1 influenza, you may enroll online or download the forms below to be faxed to 850-412-5801.
Documents below open in new window
Authorized Private Provider User Agreement For Access to Florida SHOTS
(Form DH-1479)
To better serve all of our providers when faxing Florida Shots
please fax to 850-412-5801
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.
