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Please mail one original and two copies of this completed application form, and all accompanying materials, to: HIC Secretary, State of Connecticut Department of Public Health, 410 Capitol Avenue
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How to fill out connecticut department of public

01
Visit the Connecticut Department of Public website.
02
Locate the appropriate form or online application for the service you need.
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Fill out the form or online application with accurate and complete information.
04
Double-check all information before submitting.
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Submit the form or online application as instructed by the department.

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Connecticut Department of Public Health is a state agency responsible for protecting the health and safety of the people living in Connecticut.
Healthcare facilities and providers are required to file with the Connecticut Department of Public Health.
Connecticut Department of Public Health forms can be filled out online or submitted via mail.
The purpose of Connecticut Department of Public Health is to monitor and regulate public health in the state.
Information such as patient data, healthcare facility details, and compliance with health regulations must be reported on Connecticut Department of Public Health forms.
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