Clinic Registration Application
Data Reporting Form
Application for Exemption from Clinic Registration

How to Register

  • Complete and print the registration application.
  • Return the completed application and cashier’s check or money order for $150 (payable to: Florida Department of Health) to:
    Florida Department of Health, P.O. Box 6330, Tallahassee, FL 32314
  • Submit any additional documentation not included with the original application to:
    Florida 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.

Avoid Delays

  • If the pain management clinic will not be entirely physician-owned, registration with the Florida 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.
  • The original application with the applicant’s original signature must be mailed to the Florida 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. You can access public information provided to the Florida Department of State.
  • 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.

Exemption from Pain Management Clinic Registration

You may send the completed application, including documentation, by mail:

Florida Department of Health
Board of Medicine
P.O. Box 6330
Tallahassee, FL 32314-6330

If you need assistance, please contact the board office at 850-245-4131 or email PMC_OSR@FLHealth.gov.

Relationship Requirements for Medical Doctors and Osteopathic Physicians

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 MQA Online Services using your username and password (same one used to renew the medical license). If you do not remember the username or password, select “Get Login Help”
  • Select “Maintain Related Licenses”
  • Complete the online instructions for adding (or deleting) relationships
  • Once completed, print the page for your records
  • At any time, you may use the “View Relationship Summary” to see a list of all your relationships