Be sure to complete the highlighted portions of the Apalachee Authorization form.

Once completed, please send the form and a copy of your driver’s license and/or

photo ID by email, fax, or mail to:

Address: Disclosure Management
2634-J Capital Circle NE
Tallahassee, FL 32308

Fax: (850) 523-3432

Email: medicalr@apalacheecenter.org

Upon receipt, please allow 7-10 business days to review the request. Should you have any questions,

please call (850) 523-3333 ext. #5557