To help reduce time at your intake appointment, please send completed forms to referrals@impowerfl.org or via fax to 321.639.1194

English:

• Authorization to Release Information
• IMPOWER Comprehensive Consent Form
• PCP Form
• No Show/Cancellation Agreement Form

Espanol:

• Autorización para divulgar información
• Consentimiento de Admisión
• Notificaction del Doctor Primario 
• Reglas Sobre Ausencias y Cancelaciones

To download a copy of IMPOWER’s Client Manual, please click here (English) and here Español (Spanish).

For more information or questions related to these forms, please contact our Centralized Referrals and Scheduling Unit at (321) 639-1224; option 2 or email referrrals@impowerfl.org.