CONDITIONING: I understand that completing this authorization form is voluntary. I realize that treatment will not be denied if I refuse to sign this form.If you have any questions, please call 954-5 19-1260. To request your record, please complete the following form: Authorization to Disclose Confidential Information Form. Click below to get started. Welcome to the State of Florida's Online Resource for Medical Doctor, Physician Assistant and Anesthesiologist Assistant Licensing, Renewals and Information.