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The Florida Department of Health works to protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts.

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Application and Forms

Board of Medicine

  • Applications and Forms
  • Register as a Pain Management Clinic
  • Apply for Exemption from Pain Management Clinic Registration
  • PMC Relationship Requirements for Medical Doctors and Osteopathic Physicians

Pain Management Registration (pdf)

Data Reporting Form (pdf)

Application for Exemption from Pain Management Clinic Registration (pdf)

 

  • 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:

    Department of Health
    PO Box 6330
    Tallahassee, FL 32314

To avoid delays:

NOTE: 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. This process can be started through the link below.

https://ahca.myflorida.com

 

  • 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. Public information provided to the Department of State, Division of Corporations, is available at: www.Sunbiz.org
  • 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.
  • Submit any additional documentation not included with the original application to:

    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.

SUBMITTING THE APPLICATION FOR EXEMPTION FROM PAIN MANAGEMENT CLINIC REGISTRATION

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

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.

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 Online Services using your user name and password (same one used to renew the medical license). (If you do not remember the user name or password, select Get Login Help. If you are still unable to get logged in, then call (850) 488-0595 for assistance.)
  • 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.

Application Status Check