Update Your VFC Provider Information

Submitted by kzachary on Wed, 05/14/2025 - 13:36

Use this form to update your community clinic or doctor's office information on the Vaccines for Children (VFC) provider map.

Indicates required field

First Name

Last Name

Clinic or Office Name

This is a new clinic/office name.

Former Clinic/Office Name

Provider Type

Select Information to Change

Physical Address

Phone Number

Website URL

New Physical Address (Not P.O.Box)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

New Phone Number

New Website URL

Check to Acknowledge That This Information Is True and Accurate

Electronic signature (type your name)

This question is for testing whether or not you are a human