Registration

This registration portal is only for the use of authorised healthcare professionals who have received this link directly from Pfizer. By submitting your personal details you are agreeing to Pfizer collecting and using your personal information for the purpose of administering your request. Please read Pfizer's Privacy policy at the link on the bottom of this page.

Title

First Name

Last Name

Email Address

Confirm Email Address

Password

(Your password must be at least 8 characters and contain at least one number and one letter.)

Confirm Password

Provider Number

You can find your AHPRA number here - https://www.ahpra.gov.au

Speciality

Pfizer Drug Requested

Hospital/Practice

Address Line 1

Address Line 2

City

State

Post Code

Work Phone

(Provide Work Phone number including area code without spaces or special characters.)

Mobile

(Provide Mobile number including area code without spaces or special characters.)

Denotes mandatory field

CANCEL