Application and Forms
- Applications and Forms
- Register as a Pain Management Clinic
- Has My Application Been Received? Are We Registered?
- PMC Relationship Requirements for Medical Doctors and Osteopathic Physicians
- Complete and print the registration application.
- Return the completed application and cashier's check or money order for $150.00 (payable to: Florida Department of Health) to:
Department of Health
PO Box 6330
Tallahassee, FL 32314
To avoid delays:
NOTE: If the Pain Management Clinic will not be entirely physician-owned, registration with the Agency for Health Care Administration (AHCA) is required. The processing time for this registration can be lengthy; therefore AHCA registration should be completed before applying for the Pain Management Clinic Registration. This process can be started through the link below.
- The original application with the applicant's original signature must be mailed to the Department of Health (faxed copies are not acceptable).
- Be sure to answer question 11 in its entirety including names and addresses of any and all pain clinic owners, principles, officers, agents, managing employees and affiliated persons. Public information provided to the Department of State, Division of Corporations, is available at: www.Sunbiz.org
- Be sure to answer all questions on the application and have the Medical Director/Designated Physician sign and date the application.
- Post offices do not accept overnight or express packages. For faster delivery, Priority Mail (2-3 days) is accepted by post office boxes.
- Submit any additional documentation not included with the original application to:
Department of Health
Pain Clinic Registration Program
4052 Bald Cypress Way, Bin C03
Tallahassee, FL 32399-3253
- You will be contacted by a Department representative if there are issues with your application. Otherwise, you will receive your registration by mail.
- For your convenience, we are providing a list of the applications we have received and the status of those applications. This list is in Microsoft Excel format and is available online.
- The file is named "Application Status," and shows the applications we have received and status of those applications as of the date in the file name. An "Approved" status indicates that a license has been issued.
Medical and Osteopathic physicians are required to advise the Board of Medicine within 10 calendar days of beginning or ending practice at a pain-management clinic.
We have made it easy to establish the relationship between the physician and the pain-management clinic:
- Login to Online Services using your user name and password (same one used to renew the medical license). (If you do not remember the user name or password, select Get Login Help. If you are still unable to get logged in, then call (850) 488-0595 for assistance.)
- Select Maintain Related Licenses from the list on the left hand side of the screen
- Complete the online instructions for adding (or deleting) relationships
- Once done, print the page for your records
- At any time, you may use the View Relationship Summary located on the same web page to see a list of all your relationships.
Application Status Check