Pre-registration captures healthcare provider locations that intend to vaccinate and critical information about those locations needed to proceed to enrollment in the program. A site pre-registers by completing the pre-registration survey. All individual clinics will need to complete a pre-registration form. The survey will remain open.


COVID-19 Vaccination Program Provider Agreement and Profile. This document is shared for informational purposes so potential enrollment sites can familiarize themselves with the federal legal requirements of the COVID-19 Vaccination Program.


Follow these steps to complete the enrollment process:

Step 1 | Step 2 | Step 3 | Step 4 | Step 5 | Step 6