Referral Intake Form
Thank you for contacting our agency. Completing this form will be the first step needed to refer an alleged incapacitated person to the public guardianship office for services. The alleged incapacitated person must be a current resident of Osceola County, they must meet indigent status and there must be a need. This means that there are no family members, friends, or others willing to serve as their healthcare proxy, healthcare surrogate, representative payee or guardian. Guardianship through the Office of the Public Guardian is a method of last resort.
We understand that you may not have all of the information requested on this form. Please complete as much as possible. Some information is required. Submit this form and email any pertinent documents such as court documents, mental health evaluations or medical records to
. The Office of the Public Guardian maintains a waiting list. Upon the receipt of the referral, it is likely that the AIP will be placed on the waiting list. You will be called periodically to make sure you want to maintain the person on the list and you will be contacted as they are selected to be processed for guardianship through the courts. As per Florida law, the OCCOA may not serve as guardian until duly appointed by the court.
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This form was created inside of Osceola Council on Aging.