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Request a New Patient Appointment

No Referral Needed

Please complete this online form to begin the appointment scheduling process. Most insurance plans do not require a referral for an appointment. The information you provide on this form will help us get you to the right team of experts. Our Patient Access Team will contact you as soon as possible. Or, you can call us:

Patient Appointment Center: 1(888) 663-3488
Hours: Monday-Friday, 7 a.m. to 6 p.m. and Saturday, 8 a.m. to noon ET.

What You'll Need

Whether you call us or complete the online form below, you'll need to have a few things ready:

  • Patient's full name, contact information and date of birth
  • Reason for visit
  • Patient's primary insurance information

Appointment Details

What best describes your first appointment at Moffitt?
Would you be interested in learning about clinical trials at Moffitt?
Do you have an insulin pump or glucose monitor?
Have you ever had a Mammogram before?
Have you ever been diagnosed with breast cancer?
Are you currently experiencing any breast problems?
Are you 50 years of age or older?
Have you ever had a Lung Screening CT before?
Do you have a primary care provider?
Are you interested in smoking cessation resources?
How were you referred to Moffitt?

Appointment Preferences

Do you have a preferred Moffitt location?
Are you requesting to see a specific Moffitt provider?

Patient Contact Information

Do you give permission for Moffitt to text you about your appointment?

Patient Insurance Information

Is the patient the policy holder?
Does the patient have secondary insurance, or a Medicare Supplement (Medigap) Plan?

Please Note: If you are an international patient (including Puerto Rico, US citizens residing abroad, and foreign nationals who reside outside the US longer than 6 months per year), please complete the International Patient Appointment Request form, contact the International Patient Services Department at International@Moffitt.org or call 813-745-4685, and an International Coordinator will assist you.

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Si no encuentra la información que busca o si desea programar una cita, llámenos gratis al 1-888-663-3488.

Gracias.

 

 

 

 

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