You must read and agree to the following disclaimer before submitting the Pre-Registration Form for Patient Referral.
You understand that your use of this New Patient Appointment Center Web page is not a substitute for seeing a doctor or medical professional regarding your medical condition. We will notify you when an appointment is scheduled. Of course, a patient relationship cannot be established until you are seen in person at Moffitt by Moffitt's medical staff.
By clicking "Submit", you agree to the terms of this Disclaimer. If you do not agree to the terms of this Disclaimer, you may call Moffitt at 813-745-3980 or 1-888-860-2778 to begin the registration process. Thank you for pre-registering with our on-line form.