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.

This form is for vaccination providers that are not general practitioners.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 13 November 2018

Was this page useful?
Why?
Why not?

Thank you for your feedback.