Australian Immunisation Register (AIR) - application to register as a vaccination provider form (IM004)
Use this form to register as a vaccination provider with the Australian Immunisation Register (AIR) before sending immunisation data.
Download and complete the Australian Immunisation Register (AIR) - application to register as a vaccination provider form.
This form is for vaccination providers that are not general practitioners.
This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.
If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.
Page last updated: 20 February 2020
This information was printed 10 September 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/im004. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.