Required Information for Self-Referral

---

This is a short term program designed to support reintegration into the community following a traumatic brain and/or traumatic spinal cord injury. To determine your eligibility, we require the following information:

• Copies of your original injury related medical records.
• Copies of current medical documentation related to your original injury.
• A completed Medical Eligibility Screening Form (MESF), filled out by your current treating physician.

Available for download you will find the blank MESF, the Florida Statutes related to the program to help you understand the specific requirements for receiving services, and a program flyer.

If you have any questions, please don’t hesitate to Contact Us.