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You can apply to enroll in the AFC program in Indiana by completing the Immunization Provider Contact Request form and faxing the completed form to the Immunization Division at (317) 233-3719.
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How to fill out immunization provider contact request
How to fill out immunization provider contact request
01
Step 1: Start by gathering all the required information for the immunization provider contact request form.
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Step 2: Open the immunization provider contact request form on your computer or print it out if you prefer to fill it out manually.
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Step 3: Fill out the form with your complete contact details, including your name, address, phone number, and email address.
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Step 4: Provide information about your immunization provider, such as their name, address, phone number, and email address.
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Step 5: Specify the type of immunization services you require and any additional details or notes you want to include.
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Step 6: Double-check all the information you have filled out to ensure its accuracy and completeness.
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Step 7: Submit the completed immunization provider contact request form through the designated submission method, which may include online submission or mailing it to the appropriate authorities.
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Step 8: Await a response from the immunization provider or relevant authorities regarding your request.
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Step 9: Follow up if necessary or as instructed by the immunization provider or authorities.
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Step 10: Keep a copy of the submitted form for your records.
Who needs immunization provider contact request?
01
Anyone who requires immunization services or has inquiries related to immunization providers should fill out the immunization provider contact request form.
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