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FLORIDA MEDICAL & INJURY CENTER, INC. 322 N. John Young Pkwy Kissimmee, Florida 34741 Phone (407) 9449355 Fax (407) 9331237Date: Birth Date: Last Name: First Name: Midnight: Address: City: St: Zip:

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Florida Medical & Injury Form may be needed by individuals who have been involved in an accident or suffered an injury in the state of Florida. This form is typically used to document and report the details of the incident, including any medical treatment received and associated expenses. It may be required by insurance companies, legal representatives, or government agencies when filing a claim or seeking compensation for damages. Anyone who has experienced a medical or injury-related incident in Florida might need to fill out this form.

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