Public Comment Form

The OMMU Wants to Hear From You!

Please inform us of your questions, comments, or concerns by filling out and submitting the form below.
Should you have a complaint about your qualified physician, you may file it here.

Please note, 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 this office by phone or in writing.

 

Required fields are marked with an asterisk (*)

First Name:
Last Name:
Email:
Phone:
Organization Name:
Organization Type: *

City:

State:

Zip/Postal Code:

Comment Type: *

Public Comment:*