Preauthorization Form and ID Cards

Where You Are:

Please bring:

  • Your health insurance identification cards *
  • Your outpatient prescription benefit card
  • Your referral preauthorization number and form.
  • Your photo ID, such as a driver's license.

Be assured all information will be kept in the strictest of confidence, and no reports will be submitted to anyone without your permission.

If you have any questions about your upcoming appointment or what to bring, please call Moffitt at 813-745-8450 or 1-800-456-3434, ext. 8450.

* Note: We accept checks, cash or credit cards for co-payment or deductibles.

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