New Client Appointment Request
This form is intended for attorneys to assist their clients in setting appointments for a FREE accident injury medical consultation, diagnostics and treatment. Submission of the form is not verification that the client is scheduled - it is merely a request for an appointment.
Please fill out the following form, and a representative from Broward Outpatient Medical Center will call shortly to confirm an appointment time.
NOTE: HIPAA Medical Records Release Form
If you are submitting a client for the first time, it it is important that you file a HIPAA Release Form, or we will not be able to release the client's files to you on request. For a copy of an executable HIPAA Medical Records Release form, please click here: HIPAA Medical Records Release form. Please email the signed HIPAA release to Patientadvocateteam@Browardoutpatient.com