To help reduce time at your intake appointment, please complete the requested intake forms via the Patient Portal or send completed forms to [email protected] 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 [email protected].