IPN Consultation Form

Please fill out the consultation form below, starting with your relationship to the practitioner.

Please Note: ***Completing this online form does not constitute a formal referral to IPN****

This form may be used for you to initiate contact with IPN regarding concern for potential impairment of a pracititioner. IPN must be able to contact you to corroborate the information provided.


The mission of IPN is to ensure public health and safety by providing education, monitoring, and support to nurses in the State of Florida