New Mexico Department of HealthCOVID-19 Vaccine Provider Portal

COVID-19 Vaccine Provider Interest Form

Interested in becoming a COVID-19 vaccine provider? Fill out this form, and a representative from NM DOH will reach out to answer your questions and help you through the certification process.

Organization Name:
Point of Contact
First Name
Last Name
Confirm Email
Confirm Phone

Thank you for your interest. A representative from NM DOH should contact you in the next 48 hours. Please monitor your inbox, spam, and junk for an email from NM DOH <>.

If you don't receive any communication within 48 hours, please contact us at