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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.

Online Forms

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)
Financial Assistance Application (online)
Upload Identification

Printable Forms

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

We are excited to announce the new Flagler County Coordinated Opioid Recovery (CORe) initiative providing whole-person care for those suffering with opioid use disorder

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