Release of Information Requests

The forms below are intended for use only by current or previously covered healthcare providers. Questions related to the use and/or completion of the forms should be directed to the SIP Insurance Services team at (352) 273-7006 -or- 844-MY FL SIP, or via email at one of the following addresses:

Release of Claim and/or Suit Information

University of Florida

Authorization for Release of Information

Downloadable / Printable | Electronic

Florida State University

Authorization for Release of Information

Downloadable / Printable | Electronic

University of Central Florida

Authorization for Release of Information

Downloadable / Printable | Electronic

Florida International University

Authorization for Release of Information

Downloadable / Printable | Electronic

Florida Atlantic University

Authorization for Release of Information

Downloadable / Printable | Electronic


This webpage, Release of Information Requests, is managed by Lynette Belforti, Operations & Underwriting Officer.
Please feel free to contact her for any questions or recommendations regarding page content.