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---ADHDALS (Lou Gehrig’s)AlcoholismAlzheimer’sAnorexiaAnxietyArthritis (Other)Asperger’s DisorderAutismCancerCerebral PalsyChemotherapy Side EffectsChronic Nonmalignant PainChronic Pain (any kind)Crohn’s DiseaseDementiaDepressionDermatomyositisDiabetesDiverticulitisDystoniaEndometriosisEpilepsyEssential Tremor (Kinetic)FibromyalgiaGERDGlaucomaHepatitis CHirayama DiseaseHIV/AIDSInflammatory Bowel DiseaseInsomniaIrritable Bowel SyndromeLupusLyme DiseaseMeniere’s DiseaseMigraine HeadachesMultiple SclerosisMuscle SpasmsMuscular DystrophyMyasthenia Gravis (MG)NauseaNeuropathyObesityObsessive-Compulsive Disorder (OCD)OsteoarthritisOvarian CystsOverweightParkinson’s DiseasePost Traumatic Stress (PTSD)PsoriasisRadiation Therapy Side EffectsRestless Leg SyndromeRheumatoid ArthritisSeizuresSarcoidosisSickle Cell AnemiaSpinal Cord InjuryTardive DyskinesiaTMarijuanaTourette’sTraumatic Brain InjuryUlcerative Colitis (UC)VertigoTerminal Condition

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While only Florida residents are eligible, seasonal residents ("snowbirds") may qualify if they temporarily reside in Florida for 31 consecutive days a year and are registered to vote or pay income tax in another state. By completing this form, you acknowledge that Best Medical Card may contact you via phone and/or email.