386-319-9483
Forms
You can find important Flagler Cares’ Client forms here.
Forms can be filled out and signed completely online with a computer or smart phone or can be downloaded, printed, and filled out by hand.
Choose these forms to fill out and sign completely online with a computer or smart phone. You may be required to upload documents.
Consent Form (online)
Upload Identification
Upload Health Insurance Card
Client Handbook Acknowledgement
Choose these forms to download, print, complete and return to Flagler Cares (information below).
Consent Form (printable)
Financial Assistance Application (printable)
Authorization for Release of Medical Records Information
Release of Information
Return by Mail: Flagler Cares, 160 Cypress Point Parkway, Suite B302, Palm Coast, FL 32164
Return by Fax: 386-463-1030
Return in Person: Flagler County Village, M-F, 8:30 to 4:30 p.m., City Marketplace, Building B, 3rd Floor, 160 Cypress Point Parkway, Suite B302, Palm Coast, FL 32164
Return by Email: help@flaglercares.org