*The online form cannot be saved. Please collect all your information and enter the information into this online form.
*Be prepared to UPLOAD the following items before starting this form:
1. Training certificates for the designated primary vaccine coordinator, secondary vaccine coordinator, and the Provider of Record (MD, DO, PA, NP) contacts.
2. The signed CDC Provider Agreement and Colorado VFC Supplemental Provider Agreement.
3. The refrigerator and freezer thermometer calibration certificates.
Download the training instructions and agreements here:
Colorado VFC Annual Training Course Instructions
CDC Provider Agreement
Colorado VFC Supplemental Provider Agreement
*Hit the SUBMIT button at the end of this form. After SUBMITTING the application, an email confirmation will be sent. Keep a copy of the enrollment application.
Please contact the VFC Program at cdphe_vfc@state.co.us or at 303-692-2650 if you have questions or need additional information.