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Trouble logging in? Forgot password? We can help!

philavax@phila.gov

215-685-6784

215-238-6944


Register a clinic

Fill out both forms, then either email or fax them to us at the contact above.

Clinic registration form
Provider agreement form

On behalf of patients

Request or update record
Patient update request

Looking for something else?

PhilaVax program info
Flat file reporting guide
More PhilaVax resources

Bridge Access Program Pre-Enrollment is Live

Bridge Access Program Pre-Enrollment is Live

Bridge Access Program Pre-Enrollment is Live

Please complete the pre-enrollment survey below. This survey will provide our team with key information to determine if your site is eligible for enrollment.  

The survey does not generate a confirmation email automatically. Our team will review your responses and reach out to you within 48 hours to provide next steps and/or to request additional information as needed.

As a reminder, the Bridge Access Program allows providers who see underinsured and uninsured adults 19+ to continue receiving government funded COVID-19 vaccine following commercialization. 

If you have additional questions about enrollment you may email the COVID-19 Coordinator, nyandra.mcfadden@phila.gov.