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Florida Department of Elder Affairs Assistance Form


Contact Information: (Fields required are marked with *)
 


      


Your name and contact information is requested in case more information is needed to resolve your issue.  If you wish to remain anonymous, please do not use this form. Instead, please send an email to information@elderaffairs.org and provide as much detail as possible. Without enough detail, we may not be able to resolve your issue; however, your input is important to us and will be used to better our customer service.

Thank you for completing this form. After you click the ‘Submit’ button above, a copy of your email will be sent to the address that you provided.

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact the Department at 850-414-2000.