When requesting access to the North Dakota Immunization Information System (NDIIS),
it is important that your provider site has a current, fully executed Provider Site Agreement on file with the ND Department of Health Division of Immunizations.
Please complete the form below in its entirety. Once the form has been submitted, NDIIS Support Services will contact your Site Administrator for approval.
The Site Administrator must reply back to the Support team within 5 business days in order for them to proceed with your access request.
Once they receive approval from the Site Administrator, Support Services will complete the set up of your access and will contact you directly with your login information.
If you are experiencing issues with the form, please contact NDIIS Support Services at