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CVIP registration form

Please complete 1 form per clinic.

Use this form to complete step 2 of the CVIP registration process. Please check the full registration process on our web page.
You can also use this form to add providers to your registered organisation.
For urgent registrations, or if you want to remove providers for a registered clinic, please call the CVIP helpline 1800 723 471 (option 3)

Privacy Collection Notice

When you give us personal information, either of yourself or providers you are registering, we will use it to provision access to the Clinician Vaccine Integrated Platform (CVIP) and create a CVIP account. This includes accessing the personal information providers have stored against their Provider Digital Access (PRODA) registration. This allows us to: 
  • verify provider identity
  • register providers as users in CVIP
  • link providers to the clinic(s) at which they work
  • create printouts of vaccination activity for provider use.
We preload clinics into CVIP, so providers can select which one they are working in when they are giving vaccinations. Please note that providers will use their PRODA login details to access CVIP. When you give us personal information for provider registration, we will store it as part of the provider CVIP account.

If you would like more information about how we handle personal information, you can find this in the full CVIP Collection Notice.

Clinic data

All fields are mandatory unless marked optional.
Clinic data
Contact details
We will use the details below to confirm your registration and to contact you about your CVIP account in future, if needed.

Provider data

Ensure you have consent from all healthcare providers you are registering below.
If you have an organisation AIR provider number, this can be copied for all providers.
Use the + and - buttons to add or remove rows.
First name Last name PRODA RA number AIR or Medicare provider number Operations
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