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SureCheck Online Registration Form

Florida Department of Health in Broward County

Contact

Florida Department of Health in Broward County
HIV Prevention Program
SureCheck Training Course Registration

2023 DOH-Broward HIV Prevention Program Training Schedule

To complete your registration, you must scan and email your un-expired HIV 501 or HIV 501 Annual Update certificate to WebRegistration.CHD06@flhealth.gov . A HIV 501 online certificate is not accepted for this registration.

For more information please call 954-847-8132
or email to: WebRegistration.CHD06@flhealth.gov

SureCheck Training Class Online Registration Form

Fields marked with an asterisk (*) are required.

Request Date for SureCheck Class*

Name of Participant*

Participant Address*

Participant E-mail Address*

Participant Phone Number*

Testing Agency Name and FDOH Site Number

Testing Site Manager Name

Testing Agency Address

Testing Agency City and Zip Code

Testing Agency Telephone Number*

Enter Confirmation Number