Patient Feedback Form
If you are having an emergency, please call 911. This email system is for questions and comments that are generic in nature such as member questions, new card requests or inquiries from the general public or media. This system is not intended for time-sensitive, health-related matters. Please DO NOT SEND PERSONAL MEDICAL INFORMATION via email communication.
You do not have to provide your name if you don't wish to be identified.
You do not have to provide your e-mail address if you don't wish to be identified.
Mandatory field(s) marked with *
*Correspondence via Email: “Under Florida law, email addresses and all of the information contained in the emails are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.”