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.
- Checklist for Pathology Consultation
- Anatomic Pathology Consultation Request Form (Tissue)
- Hematopathology Consultation Request Form (Blood)
- Pathology Release of Information Form
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:
Office Hours: Monday - Friday, 8 a.m. to 6 p.m.
Saturday, Sunday and Holidays - Closed