Applications and Forms

How to Register

  • 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: Florida Department of Health, PO Box 6330 Tallahassee, FL 32314
  • Submit any additional documentation not included with the original application to the Florida Department of Health’s Pain Clinic Registration Program at 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 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 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 Department of State, Division of Corporations online.
  • 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.

Apply for Exemption from Pain Management Clinic Registration

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

Florida Department of Health
Board of Medicine
Post Office Box 6330
Tallahassee, Florida 32314-6330

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

PMC 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:

  • Log in 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” 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.