Request for Consultation - Forms

Click on the links below to obtain a downloadable Consultation Request Form. Please note that you will have the option to print and manually complete and fax the form or to complete and submit the form electronically. In addition, we have included a pathology consultation checklist in order to assist you in gathering the documents, materials and reports needed. The Release of Information form would need to be filled out if a patient is requesting their material be sent to another facility.

It is important that the consultation request form is complete in order to avoid delays in processing.

Attention to referring physician’s name, contributing facility, patient’s demographic and billing information (with copies of insurance cards) is extremely important.

Please enclose the completed form within the package. If the consultation request form is incomplete, the slides will not be reviewed until all needed information is updated and completed. Send the completed form, along with all materials to be reviewed with corresponding pathology report(s) to:

Moffitt Cancer Center 
Department of Pathology 
ATTN: Expert Consult 
12902 USF Magnolia Drive 
MCC – 2nd Floor, RM 2049 
Tampa, Florida 33612 
Tel: 813-745-3001 • Fax: 813-745-8479 

NOTE: Overnight delivery via UPS or Federal Express is preferred.

Pathology Services Contact Information

For general information on utilizing pathology services, or any questions concerning service issues, please contact our office:

Phone: 813-745-3001 
Fax: 813-745-8479 
Office Hours: Monday - Friday, 8 a.m. to 6 p.m. 
Saturday, Sunday and Holidays - Closed