Drive Legal Appointment Form - Eleventh Judicial Circuit of Florida

A $20.00 fee will be charged for every missed appointment where a cancellation, or request for rescheduling, has not been received by the program with at least 24 hours' notice.

First Name:

Last Name:

Date of Birth:

Phone Number:

E-mail:

Driver's License No:

Desired Location:

Desired Service:

Desired Week:

Desired Time:

How did you hear about the program?

Notes: (Provide any additional Case information here)