New Patient Intake Form

This intake helps our licensed physician review your medical history for a Florida window tint medical exemption (FLHSMV form HSMV 83390). It takes about 5–10 minutes.

What we’ll ask

• Vehicle owner information
• Who the exemption is for
• Medical history
• Vehicle details (up to 3 vehicles)
• A copy of your Florida driver license or ID

How it works

1. Complete this intake.
2. A licensed physician reviews your file and reaches out within 24–48 hours.
3. Your total is $300.00 (covers up to 3 vehicles). We’ll collect payment upon preliminary approval.
4. If approved, you sign your section, the physician signs theirs, and we send you instructions to mail the form to the state with the $6.50 per-vehicle state fee.