FLSHOTS logo Applicant Questionnaire Department of Health Logo

Note: If you can already directly access Florida SHOTS, and/or communicate via EMR/EHR, then please log in as usual and proceed to "Enrollment", located under "COVID-19" in the main system menu. Separate enrollment forms are not necessary for additional providers. Also, if you would like to include other sites with your organization, we can add them for you without new enrollment forms. To find out if your organization already participates in Florida SHOTS , please call our Helpdesk for assistance.

1. Will the computer(s) in the location(s) used to access Florida SHOTS meet the following minimum requirements?
  • Windows 10 or higher
  • Internet Explorer 11 (or higher), Edge, Chrome, or Firefox (ver 51 or higher)
  • Adobe PDF Reader (or equivalent)
  • Access to the Internet
          Yes   No
 
2. Do you hold a valid and active medical license under Chapters 458, 459, or 464, F.S. (ME, OS, APRN, RN, PN, PA, ACN, LL, or CNS), or are you a chiropractor licensed under Chapter 460, F.S. (CH) who administers physicals for school enrollment? See also: http://www.flsenate.gov/statutes/
          Yes   No
 
Note to Pharmacists To enroll in Florida SHOTS, Pharmacists should contact the Florida SHOTS enrollment desk at (877) 888-7468 (SHOT).