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Non-Compliance Referral Form

The following options are available for those who do not want to fill out the referral on-line:

Download e-mail Referral Form
This Referral Form is a Microsoft Word Document that you can open, fill out and e-mail back to the Bureau of Compliance at:

Gregory.Mills@fldfs.com

Download Referral Form
This Referral Form is in PDF format that can be downloaded by anyone who has Adobe Reader. Print the Referral Form, complete and mail to:

Gregory Mills - BOC Analyst
Division of Workers Compensation
200 East Gaines Street
Tallahassee, FL 32399-4228

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