Licensure Forms For All Applicants As Required By Law
The following licensure application forms are for use by health care providers regulated under Chapter 408, Part II, Florida Statutes.
Licensure and/or certification forms for the following provider types may be found below:
Submit Online - Providers can submit renewal and change during licensure period applications through the Agency's Online Licensing System indicated below. Initial applications for most provider types may also be submitted online.
Tips for submitting applications:
- Make check/money order payable to the Agency for Health Care Administration (AHCA).
- If payment is made out to the State of Florida or CLIA, it will be returned.
- Payments for application fees must accompany the application.
- If payment is not submitted with the application, it will be returned.
- Renewal Applications must be submitted and paid prior to the expiration date.
- Renewals may be submitted not more than 120 days before expiration.
Forms for use by all provider types.
Health Care Licensing Application Addendum AHCA Form 3110-1024 Recommended Form
Health Care Licensing Application Addendum AHCA Form 3110-1024 Form Authorized by Rule