www.moffitt.org
Open in
urlscan Pro
2606:4700:4400::6812:27b6
Public Scan
URL:
https://www.moffitt.org/
Submission: On September 07 via manual from US — Scanned from DE
Submission: On September 07 via manual from US — Scanned from DE
Form analysis 4 forms found in the DOM
GET /site-search/
<form action="/site-search/" method="get" role="search">
<label for="search" class="visually-hidden">Search</label>
<input id="search" name="query" type="search" placeholder="Search" autocomplete="off" aria-label="Enter a search term">
<button aria-label="Search Button"><span class="fa fa-search"></span></button>
</form>GET /find-a-doctor-search/
<form action="/find-a-doctor-search/" method="get" aria-label="Find a Doctor">
<div class="search-form-row">
<div class="form-field js-select-to-query">
<label for="cancer-type">Cancer Type</label>
<select class="js-select" id="cancer-type">
<option value="">Select</option>
<option value="No Preference">No Preference</option>
<option value="Adrenal Carcinoma">Adrenal Carcinoma</option>
<option value="Anal Cancer">Anal Cancer</option>
<option value="Appendiceal (Appendix) Cancer">Appendiceal (Appendix) Cancer</option>
<option value="Astrocytoma">Astrocytoma</option>
<option value="Basal Cell Carcinoma">Basal Cell Carcinoma</option>
<option value="Bladder Cancer">Bladder Cancer</option>
<option value="Brain Cancer">Brain Cancer</option>
<option value="Breast Cancer">Breast Cancer</option>
<option value="Cervical Cancer">Cervical Cancer</option>
<option value="Cholangiocarcinoma (Bile Duct Cancer)">Cholangiocarcinoma (Bile Duct Cancer)</option>
<option value="Colon Cancer">Colon Cancer</option>
<option value="Colorectal Cancer">Colorectal Cancer</option>
<option value="Cutaneous Lymphoma (CTCL)">Cutaneous Lymphoma (CTCL)</option>
<option value="Ductal Carcinoma In Situ">Ductal Carcinoma In Situ</option>
<option value="Endometrial (Uterine) Cancer">Endometrial (Uterine) Cancer</option>
<option value="Esophageal Cancer">Esophageal Cancer</option>
<option value="Gallbladder Cancer">Gallbladder Cancer</option>
<option value="Gastrointestinal Carcinoid Tumor">Gastrointestinal Carcinoid Tumor</option>
<option value="GIST (Gastrointestinal Stromal Tumor)">GIST (Gastrointestinal Stromal Tumor)</option>
<option value="Glioblastoma">Glioblastoma</option>
<option value="Head and Neck Cancer">Head and Neck Cancer</option>
<option value="Her 2 positive">Her 2 positive</option>
<option value="Hodgkin Lymphoma">Hodgkin Lymphoma</option>
<option value="Inflammatory Breast Cancer">Inflammatory Breast Cancer</option>
<option value="Invasive Ductal Carcinoma">Invasive Ductal Carcinoma</option>
<option value="Kidney (Renal Cell) Cancer">Kidney (Renal Cell) Cancer</option>
<option value="Leukemia">Leukemia</option>
<option value="Liver Cancer">Liver Cancer</option>
<option value="Lung Cancer">Lung Cancer</option>
<option value="Melanoma">Melanoma</option>
<option value="Meningioma">Meningioma</option>
<option value="Merkel Cell Carcinoma">Merkel Cell Carcinoma</option>
<option value="Mesothelioma">Mesothelioma</option>
<option value="Metastatic Breast Cancer">Metastatic Breast Cancer</option>
<option value="Multiple Myeloma-Plasma Cell Tumor">Multiple Myeloma-Plasma Cell Tumor</option>
<option value="Myelodysplastic Syndromes (MDS)">Myelodysplastic Syndromes (MDS)</option>
<option value="Neuroendocrine Tumor">Neuroendocrine Tumor</option>
<option value="Neurofibromatosis">Neurofibromatosis</option>
<option value="Non-Hodgkin Lymphoma">Non-Hodgkin Lymphoma</option>
<option value="Oral Cavity or Throat Cancer">Oral Cavity or Throat Cancer</option>
<option value="Osteosarcoma">Osteosarcoma</option>
<option value="Ovarian Cancer">Ovarian Cancer</option>
<option value="Pancoast Tumor">Pancoast Tumor</option>
<option value="Pancreatic Cancer">Pancreatic Cancer</option>
<option value="Penile Cancer">Penile Cancer</option>
<option value="Pituitary Adenoma">Pituitary Adenoma</option>
<option value="Prostate Cancer">Prostate Cancer</option>
<option value="Rectal Cancer">Rectal Cancer</option>
<option value="Sarcoma">Sarcoma</option>
<option value="Skin Cancer (Nonmelanoma)">Skin Cancer (Nonmelanoma)</option>
<option value="Small Intestine Cancer">Small Intestine Cancer</option>
<option value="Spinal Tumor">Spinal Tumor</option>
<option value="Squamous Cell Carcinoma">Squamous Cell Carcinoma</option>
<option value="Stomach (Gastric) Cancer">Stomach (Gastric) Cancer</option>
<option value="Testicular Cancer">Testicular Cancer</option>
<option value="Thymoma">Thymoma</option>
<option value="Thyroid Cancer">Thyroid Cancer</option>
<option value="Triple Negative Breast Cancer">Triple Negative Breast Cancer</option>
<option value="Vaginal Cancer">Vaginal Cancer</option>
<option value="Vulvar Cancer">Vulvar Cancer</option>
</select>
<input class="visually-hidden" hidden="" aria-hidden="true" tabindex="-1" name="cancer-type" id="cancer-type" value="">
</div>
<div class="form-field js-select-to-query">
<label for="specialty">Specialty</label>
<select class="js-select" id="specialty">
<option value="">Select</option>
<option value="No Preference">No Preference</option>
<option value="Anesthesiology">Anesthesiology</option>
<option value="Cardiology">Cardiology</option>
<option value="Clinical Psychology">Clinical Psychology</option>
<option value="Dermatology">Dermatology</option>
<option value="Endocrinology">Endocrinology</option>
<option value="Family Medicine">Family Medicine</option>
<option value="Gastroenterology">Gastroenterology</option>
<option value="Genetics">Genetics</option>
<option value="Gynecologic Oncology">Gynecologic Oncology</option>
<option value="Head and Neck Surgery">Head and Neck Surgery</option>
<option value="Hematology">Hematology</option>
<option value="Hematology/Oncology">Hematology/Oncology</option>
<option value="Hospice">Hospice & Palliative Medicine</option>
<option value="Infectious Diseases">Infectious Diseases</option>
<option value="Internal Medicine">Internal Medicine</option>
<option value="Interventional Radiology">Interventional Radiology</option>
<option value="Medical Oncology">Medical Oncology</option>
<option value="Neuro Oncology">Neuro Oncology</option>
<option value="Neurology">Neurology</option>
<option value="Neurosurgery">Neurosurgery</option>
<option value="Otolaryngology">Otolaryngology</option>
<option value="Pain Medicine">Pain Medicine</option>
<option value="Pathology">Pathology</option>
<option value="Plastic Surgery">Plastic Surgery</option>
<option value="Psychiatry">Psychiatry</option>
<option value="Pulmonology">Pulmonology</option>
<option value="Radiation Oncology">Radiation Oncology</option>
<option value="Radiology">Radiology</option>
<option value="Surgery">Surgery</option>
<option value="Thoracic Surgery">Thoracic Surgery</option>
<option value="Urology">Urology</option>
</select>
<input class="visually-hidden" hidden="" aria-hidden="true" tabindex="-1" name="specialty" id="specialty" value="">
</div>
<div class="form-field js-select-to-query">
<label for="location">Location</label>
<select class="js-select" id="location">
<option value="">Select</option>
<option value="1">Moffitt Cancer Center, Magnolia Campus</option>
<option value="21">Moffitt Cancer Center at International Plaza</option>
<option value="22">Moffitt Cancer Center, Richard M. Schulze Family Foundation Outpatient Center at McKinley Campus</option>
<option value="41">Moffitt Cancer Center at Wesley Chapel</option>
</select>
<input class="visually-hidden" hidden="" aria-hidden="true" tabindex="-1" name="location" id="location" value="">
</div>
<div class="form-field js-select-to-query">
<label for="gender">Gender</label>
<select class="js-select" id="gender">
<option value="">Select</option>
<option value="No Preference">No Preference</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
</select>
<input class="visually-hidden" hidden="" aria-hidden="true" tabindex="-1" name="gender" id="gender" value="">
</div>
<div class="form-field js-select-to-query">
<label for="department-program">Department or Program</label>
<select class="js-select" id="department-program">
<option value="">Select</option>
<option value="No Preference">No Preference</option>
<option value="Adolescent and Young Adult">Adolescent Young Adult</option>
<option value="Anesthesiology">Anesthesiology</option>
<option value="Blood and Marrow Transplant and Cellular Immunothe">Blood and Marrow Transplant and Cellular Immunotherapy</option>
<option value="Breast Oncology">Breast Oncology</option>
<option value="Cutaneous Oncology">Cutaneous Oncology</option>
<option value="Diagnostic Imaging and Interventional Radiology">Diagnostic Imaging and Interventional Radiology</option>
<option value="Endocrine Oncology">Endocrine Oncology</option>
<option value="Gastrointestinal Oncology">Gastrointestinal Oncology</option>
<option value="Genetics">Genetics</option>
<option value="Genitourinary Oncology">Genitourinary Oncology</option>
<option value="Gynecologic Oncology">Gynecologic Oncology</option>
<option value="Head and Neck Oncology">Head and Neck Oncology</option>
<option value="Head and Neck-Endocrine Oncology">Head and Neck-Endocrine Oncology</option>
<option value="Individualized Cancer Management">Individualized Cancer Management</option>
<option value="Infectious Diseases">Infectious Diseases</option>
<option value="Internal">Internal & Hospital Medicine</option>
<option value="Internal Medicine">Internal Medicine</option>
<option value="Malignant Hematology">Malignant Hematology</option>
<option value="Malignant Hematology and Cellular Therapy at Memor">Malignant Hematology and Cellular Therapy at Memorial Healthcare System</option>
<option value="Neuro-Oncology">Neuro-Oncology</option>
<option value="Pathology">Pathology</option>
<option value="Radiation Oncology">Radiation Oncology</option>
<option value="Sarcoma">Sarcoma</option>
<option value="Senior Adult Oncology">Senior Adult Oncology</option>
<option value="Supportive Care Medicine">Supportive Care Medicine</option>
<option value="Thoracic Oncology">Thoracic Oncology</option>
</select>
<input class="visually-hidden" hidden="" aria-hidden="true" tabindex="-1" name="department-program" id="department-program" value="">
</div>
</div>
<div class="search-form-row">
<div class="form-field">
<label for="query">Keywords</label>
<input name="query" id="keyword" type="search" placeholder="Who can we help you find?" value="" aria-label="Search by Keywords">
</div>
<div class="form-field submit">
<button type="submit" aria-label="Submit search">Search</button>
</div>
</div>
</form>POST
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id="3c761689-b3ad-48c3-b715-a700a0b314e4">
<script type="text/javascript">
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// TECHNOTE: all serverside (paths, dynamic values) of EPiServerForms will be transfered to client side here in this section.
(function initializeOnRenderingFormDescriptor() {
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// whether this Form can be submitted which relates to the visitor's data (cookie, identity) and Form's settings (AllowAnonymous, AllowXXX)
SubmittableStatus: {
"submittable": true,
"message": ""
},
ConfirmMessage: "Submitting request",
ResetConfirmMessage: "",
ShowNavigationBar: true,
ShowSummarizedData: false,
// serialize the dependency configuration of this form to clientside
DependenciesInfo: JSON.parse(
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};
/// TECHNOTE: Calculation at FormInfo level, and these values will be static input for later processing.
workingFormInfo.StepsInfo.FormHasNoStep_VirtualStepCreated = false; // this FLAG will be true, if Editor does not put any FormStep. Engine will create a virtual step, with empty GUID
workingFormInfo.StepsInfo.FormHasNothing = false; // this FLAG will be true if FormContainer has no element at all
workingFormInfo.StepsInfo.AllStepsAreNotLinked = true; // this FLAG will be true, if all steps all have contentLink= ="" (emptyString)
})();
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<div class="Form__Element FormSelection ValidationRequired hide" data-f-element-name="__field_1110" data-f-type="selection"> <label for="35263ce8-297d-4a20-939e-1a8566efbb03" class="Form__Element__Caption">What is the known or suspected cancer
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<option value="Adrenal Nodules" data-f-datainput="">Adrenal Nodules/Adrenal Mass</option>
<option value="Anal Cancer" data-f-datainput="">Anal Cancer</option>
<option value="Appendiceal (Appendix) Cancer" data-f-datainput="">Appendiceal (Appendix) Cancer</option>
<option value="Basal Cell Carcinoma" data-f-datainput="">Basal Cell Carcinoma</option>
<option value="Bladder Cancer" data-f-datainput="">Bladder Cancer</option>
<option value="Brain Cancer" data-f-datainput="">Brain Cancer</option>
<option value="Breast Cancer" data-f-datainput="">Breast Cancer</option>
<option value="Ductal Carcinoma In Situ" data-f-datainput="">Breast Cancer - Ductal Carcinoma In Situ</option>
<option value="Inflammatory Breast Cancer" data-f-datainput="">Breast Cancer - Inflammatory</option>
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<option value="Triple Negative Breast Cancer" data-f-datainput="">Breast Cancer - Triple Negative</option>
<option value="Cervical Cancer" data-f-datainput="">Cervical Cancer</option>
<option value="Cholangiocarcinoma (Bile Duct Cancer)" data-f-datainput="">Cholangiocarcinoma (Bile Duct Cancer)</option>
<option value="Colon Cancer" data-f-datainput="">Colon Cancer</option>
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<option value="Esophageal Cancer" data-f-datainput="">Esophageal Cancer</option>
<option value="Gallbladder Cancer" data-f-datainput="">Gallbladder Cancer</option>
<option value="Gastrointestinal Carcinoid Tumor" data-f-datainput="">Gastrointestinal Carcinoid Tumor</option>
<option value="GIST(GI Stromal Tumor)" data-f-datainput="">GIST(GI Stromal Tumor)</option>
<option value="Glioblastoma" data-f-datainput="">Glioblastoma</option>
<option value="Head and Neck Cancer" data-f-datainput="">Head and Neck Cancer</option>
<option value="Kidney (Renal Cell) Cancer" data-f-datainput="">Kidney (Renal Cell) Cancer</option>
<option value="Leukemia" data-f-datainput="">Leukemia</option>
<option value="Liver Cancer" data-f-datainput="">Liver Cancer</option>
<option value="Lung Cancer" data-f-datainput="">Lung Cancer</option>
<option value="Lymphoma" data-f-datainput="">Lymphoma</option>
<option value="Hodgkin Lymphoma" data-f-datainput="">Lymphoma - Hodgkin</option>
<option value="Non-Hodgkin Lymphoma" data-f-datainput="">Lymphoma - Non-Hodgkin</option>
<option value="Melanoma" data-f-datainput="">Melanoma</option>
<option value="Meningioma" data-f-datainput="">Meningioma</option>
<option value="Merkel Cell Carcinoma" data-f-datainput="">Merkel Cell Carcinoma</option>
<option value="Mesothelioma" data-f-datainput="">Mesothelioma</option>
<option value="Multiple Myeloma-Plasma Cell Tumor" data-f-datainput="">Multiple Myeloma-Plasma Cell Tumor</option>
<option value="Myelodysplastic Syndromes (MDS)" data-f-datainput="">Myelodysplastic Syndromes (MDS)</option>
<option value="Neuroendocrine Tumor" data-f-datainput="">Neuroendocrine Tumor</option>
<option value="Neurofibromatosis" data-f-datainput="">Neurofibromatosis</option>
<option value="Oral Cavity or Throat Cancer" data-f-datainput="">Oral Cavity or Throat Cancer</option>
<option value="Osteosarcoma" data-f-datainput="">Osteosarcoma</option>
<option value="Ovarian Cancer" data-f-datainput="">Ovarian Cancer</option>
<option value="Pancoast Tumor" data-f-datainput="">Pancoast Tumor</option>
<option value="Pancreatic Cancer" data-f-datainput="">Pancreatic Cancer</option>
<option value="Penile Cancer" data-f-datainput="">Penile Cancer</option>
<option value="Pituitary Adenoma" data-f-datainput="">Pituitary Adenoma</option>
<option value="Prostate Cancer" data-f-datainput="">Prostate Cancer</option>
<option value="Rectal Cancer" data-f-datainput="">Rectal Cancer</option>
<option value="Sarcoma" data-f-datainput="">Sarcoma</option>
<option value="Skin Cancer" data-f-datainput="">Skin Cancer</option>
<option value="Small Intestine Cancer" data-f-datainput="">Small Intestine Cancer</option>
<option value="Spinal Tumor" data-f-datainput="">Spinal Tumor</option>
<option value="Squamous Cell Carcinoma" data-f-datainput="">Squamous Cell Carcinoma</option>
<option value="Stomach (Gastric) Cancer" data-f-datainput="">Stomach (Gastric) Cancer</option>
<option value="Testicular Cancer" data-f-datainput="">Testicular Cancer</option>
<option value="Thymoma" data-f-datainput="">Thymoma</option>
<option value="Thyroid Cancer" data-f-datainput="">Thyroid Cancer</option>
<option value="Thyroid Nodules" data-f-datainput="">Thyroid Nodules</option>
<option value="Vaginal Cancer" data-f-datainput="">Vaginal Cancer</option>
<option value="Vulvar Cancer" data-f-datainput="">Vulvar Cancer</option>
<option value="Other" data-f-datainput="">Other</option>
</select>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1110" data-f-validationerror="" id="__field_1110_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired hide" data-f-element-name="__field_34585" data-f-type="textbox"> <label for="8866f9b4-e92b-4d63-b4ea-31cf375f0bf8" class="Form__Element__Caption">Please explain the known or suspected
cancer type</label>
<input name="__field_34585" id="8866f9b4-e92b-4d63-b4ea-31cf375f0bf8" type="text" class="FormTextbox__Input" aria-describedby="__field_34585_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_34585" data-f-validationerror="" id="__field_34585_desc" role="alert" style="display:none"></span>
</div>
<div aria-invalid="false" aria-required="true" class="Form__Element FormChoice ValidationRequired hide" data-f-element-name="__field_28048" data-f-type="choice" id="acec1f22-02ac-4336-a21d-4002bcc31de0" required="">
<fieldset aria-describedby="__field_28048_desc">
<legend class="Form__Element__Caption">Are you interested in learning about clinical trials at Moffitt?</legend>
<div>
<input type="radio" id="acec1f22-02ac-4336-a21d-4002bcc31de0_0" name="__field_28048" value="Yes I would" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="acec1f22-02ac-4336-a21d-4002bcc31de0_0" class="FormChoice__Label"> Yes I would </label>
</div>
<div>
<input type="radio" id="acec1f22-02ac-4336-a21d-4002bcc31de0_1" name="__field_28048" value="Not at this time" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="acec1f22-02ac-4336-a21d-4002bcc31de0_1" class="FormChoice__Label"> Not at this time </label>
</div>
</fieldset>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_28048" data-f-validationerror="" id="__field_28048_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormSelection ValidationRequired hide" data-f-element-name="__field_1455" data-f-type="selection"> <label for="0ff38dc6-1891-43bf-8d25-33a0544f1882" class="Form__Element__Caption">What type of screening or exam are you
seeking?</label>
<select name="__field_1455" id="0ff38dc6-1891-43bf-8d25-33a0544f1882" required="" aria-required="true" data-f-datainput="" aria-describedby="__field_1455_desc" aria-invalid="false" autocomplete="off">
<option disabled="disabled" selected=""selected"" value=""> -- Select an option -- </option>
<option value="Annual Mammogram" data-f-datainput="">Annual Mammogram</option>
<option value="Colonoscopy" data-f-datainput="">Colonoscopy</option>
<option value="Genetic Counseling" data-f-datainput="">Genetic Counseling</option>
<option value="CT Lung Screening" data-f-datainput="">Lung Screening</option>
<option value="Other Survivorship Exam" data-f-datainput="">Other Survivorship Exam</option>
</select>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1455" data-f-validationerror="" id="__field_1455_desc" role="alert" style="display:none"></span>
</div>
<div aria-invalid="false" aria-required="true" class="Form__Element FormChoice ValidationRequired" data-f-element-name="__field_28049" data-f-type="choice" id="108ac53f-8f54-4576-acad-d979280e7e9e" required="">
<fieldset aria-describedby="__field_28049_desc">
<legend class="Form__Element__Caption">How were you referred to Moffitt?</legend>
<div>
<input type="radio" id="108ac53f-8f54-4576-acad-d979280e7e9e_0" name="__field_28049" value="I am referring myself" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="108ac53f-8f54-4576-acad-d979280e7e9e_0" class="FormChoice__Label"> I am referring myself </label>
</div>
<div>
<input type="radio" id="108ac53f-8f54-4576-acad-d979280e7e9e_1" name="__field_28049" value="I am being referred by my physician" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="108ac53f-8f54-4576-acad-d979280e7e9e_1" class="FormChoice__Label"> I am being referred by my physician </label>
</div>
<div>
<input type="radio" id="108ac53f-8f54-4576-acad-d979280e7e9e_2" name="__field_28049" value="I am being referred by my employer" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="108ac53f-8f54-4576-acad-d979280e7e9e_2" class="FormChoice__Label"> I am being referred by my employer </label>
</div>
</fieldset>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_28049" data-f-validationerror="" id="__field_28049_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired hide" data-f-element-name="__field_1454" data-f-type="textbox"> <label for="761f1d9e-bdff-4498-bea6-35ef865f459c" class="Form__Element__Caption">What is the name of the physician who is
referring you?</label>
<input name="__field_1454" id="761f1d9e-bdff-4498-bea6-35ef865f459c" type="text" class="FormTextbox__Input" aria-describedby="__field_1454_desc" placeholder="Please enter physician name" required="" aria-required="true" data-f-datainput=""
aria-invalid="false" autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1454" data-f-validationerror="" id="__field_1454_desc" role="alert" style="display:none"></span>
</div>
</section>
<section id="__field_1811" data-f-type="step" data-f-element-name="__field_1811" class="Form__Element FormStep Form__Element--NonData hide" data-f-stepindex="1" data-f-element-nondata="">
<h3 class="FormStep__Title">Appointment Preferences</h3>
<aside class="FormStep__Description"></aside>
<!-- Each FormStep groups the elements below it til the next FormStep -->
<div aria-invalid="false" aria-required="true" class="Form__Element FormChoice ValidationRequired" data-f-element-name="__field_28050" data-f-type="choice" id="629e2700-d0ff-4b9d-a7da-400694cf857a" required="">
<fieldset aria-describedby="__field_28050_desc">
<legend class="Form__Element__Caption">Do you have a preferred Moffitt location?</legend>
<div>
<input type="radio" id="629e2700-d0ff-4b9d-a7da-400694cf857a_0" name="__field_28050" value="First Available" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="629e2700-d0ff-4b9d-a7da-400694cf857a_0" class="FormChoice__Label"> First Available </label>
</div>
<div>
<input type="radio" id="629e2700-d0ff-4b9d-a7da-400694cf857a_1" name="__field_28050" value="Magnolia campus 12902 USF Magnolia Drive Tampa" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="629e2700-d0ff-4b9d-a7da-400694cf857a_1" class="FormChoice__Label"> Magnolia campus, 12902 USF Magnolia Drive, Tampa </label>
</div>
<div>
<input type="radio" id="629e2700-d0ff-4b9d-a7da-400694cf857a_2" name="__field_28050" value="McKinley clinic 10920 N. McKinley Drive Tampa" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="629e2700-d0ff-4b9d-a7da-400694cf857a_2" class="FormChoice__Label"> McKinley clinic, 10920 N. McKinley Drive, Tampa </label>
</div>
<div>
<input type="radio" id="629e2700-d0ff-4b9d-a7da-400694cf857a_3" name="__field_28050" value="International Plaza 4101 Jim Walter Blvd. Tampa" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="629e2700-d0ff-4b9d-a7da-400694cf857a_3" class="FormChoice__Label"> International Plaza, 4101 Jim Walter Blvd., Tampa </label>
</div>
<div>
<input type="radio" id="629e2700-d0ff-4b9d-a7da-400694cf857a_4" name="__field_28050" value="Wesley Chapel 2590 Healing Way Wesley Chapel" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="629e2700-d0ff-4b9d-a7da-400694cf857a_4" class="FormChoice__Label"> Wesley Chapel, 2590 Healing Way, Wesley Chapel </label>
</div>
<div>
<input type="radio" id="629e2700-d0ff-4b9d-a7da-400694cf857a_5" name="__field_28050" value="Virtual only available if patient is in Florida" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="629e2700-d0ff-4b9d-a7da-400694cf857a_5" class="FormChoice__Label"> Virtual (only available if patient is in Florida) </label>
</div>
</fieldset>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_28050" data-f-validationerror="" id="__field_28050_desc" role="alert" style="display:none"></span>
</div>
<div aria-invalid="false" aria-required="true" class="Form__Element FormChoice ValidationRequired" data-f-element-name="__field_1813" data-f-type="choice" id="ddaf45fa-77f0-4380-92ba-3c9594ad35f6" required="">
<fieldset aria-describedby="__field_1813_desc">
<legend class="Form__Element__Caption">Are you requesting to see a specific Moffitt provider?</legend>
<div>
<input type="radio" id="ddaf45fa-77f0-4380-92ba-3c9594ad35f6_0" name="__field_1813" value="yes" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="ddaf45fa-77f0-4380-92ba-3c9594ad35f6_0" class="FormChoice__Label"> Yes </label>
</div>
<div>
<input type="radio" id="ddaf45fa-77f0-4380-92ba-3c9594ad35f6_1" name="__field_1813" value="no" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="ddaf45fa-77f0-4380-92ba-3c9594ad35f6_1" class="FormChoice__Label"> No </label>
</div>
</fieldset>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1813" data-f-validationerror="" id="__field_1813_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox hide" data-f-element-name="__field_1814" data-f-type="textbox"> <label for="4c389d17-3463-4541-95a5-0e433820d04a" class="Form__Element__Caption">Please enter the name of the Moffitt provider you would like
to see.</label>
<input name="__field_1814" id="4c389d17-3463-4541-95a5-0e433820d04a" type="text" class="FormTextbox__Input" aria-describedby="__field_1814_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1814" data-f-validationerror="" id="__field_1814_desc" role="alert" style="display:none"></span>
</div>
</section>
<section id="__field_1815" data-f-type="step" data-f-element-name="__field_1815" class="Form__Element FormStep Form__Element--NonData hide" data-f-stepindex="2" data-f-element-nondata="">
<h3 class="FormStep__Title">Patient Contact Information</h3>
<aside class="FormStep__Description"></aside>
<!-- Each FormStep groups the elements below it til the next FormStep -->
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_26090" data-f-type="textbox"> <label for="ac83d75c-aa23-4a88-abc3-99a583987ceb" class="Form__Element__Caption">First Name</label>
<input name="__field_26090" id="ac83d75c-aa23-4a88-abc3-99a583987ceb" type="text" class="FormTextbox__Input" aria-describedby="__field_26090_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="name">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_26090" data-f-validationerror="" id="__field_26090_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_26092" data-f-type="textbox"> <label for="bda8bb5c-3d87-45f8-b0bc-86075b2839cd" class="Form__Element__Caption">Last Name</label>
<input name="__field_26092" id="bda8bb5c-3d87-45f8-b0bc-86075b2839cd" type="text" class="FormTextbox__Input" aria-describedby="__field_26092_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="family-name">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_26092" data-f-validationerror="" id="__field_26092_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_1829" data-f-type="textbox"> <label for="354adfdc-ecf2-44f3-864a-839d419bc59d" class="Form__Element__Caption">Patient date of birth</label>
<input name="__field_1829" id="354adfdc-ecf2-44f3-864a-839d419bc59d" type="text" class="FormTextbox__Input" aria-describedby="__field_1829_desc" placeholder="MM/DD/YYYY" required="" aria-required="true" data-f-datainput=""
aria-invalid="false" autocomplete="bday">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1829" data-f-validationerror="" id="__field_1829_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_1832" data-f-type="textbox"> <label for="8c37027e-2eb6-4c53-bb40-9cbdf3e6065d" class="Form__Element__Caption">Patient street address</label>
<input name="__field_1832" id="8c37027e-2eb6-4c53-bb40-9cbdf3e6065d" type="text" class="FormTextbox__Input" aria-describedby="__field_1832_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="street-address">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1832" data-f-validationerror="" id="__field_1832_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_1833" data-f-type="textbox"> <label for="5f6884c7-846b-4e81-846a-b9c9eb1b721b" class="Form__Element__Caption">Patient city</label>
<input name="__field_1833" id="5f6884c7-846b-4e81-846a-b9c9eb1b721b" type="text" class="FormTextbox__Input" aria-describedby="__field_1833_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1833" data-f-validationerror="" id="__field_1833_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormSelection ValidationRequired" data-f-element-name="__field_1834" data-f-type="selection"> <label for="3a8a9bd2-d029-4e79-b14e-041646f9044d" class="Form__Element__Caption">Patient state</label>
<select name="__field_1834" id="3a8a9bd2-d029-4e79-b14e-041646f9044d" required="" aria-required="true" data-f-datainput="" aria-describedby="__field_1834_desc" aria-invalid="false" autocomplete="off">
<option disabled="disabled" selected=""selected"" value=""> -- Select an option -- </option>
<option value="AL" data-f-datainput="">Alabama</option>
<option value="AK" data-f-datainput="">Alaska</option>
<option value="AS" data-f-datainput="">American Somoa</option>
<option value="AZ" data-f-datainput="">Arizona</option>
<option value="AR" data-f-datainput="">Arkansas</option>
<option value="CA" data-f-datainput="">California</option>
<option value="CO" data-f-datainput="">Colorado</option>
<option value="CT" data-f-datainput="">Connecticut</option>
<option value="DE" data-f-datainput="">Delaware</option>
<option value="DC" data-f-datainput="">District of Columbia</option>
<option value="FSM" data-f-datainput="">Federated States of Micronesia</option>
<option value="FL" data-f-datainput="">Florida</option>
<option value="GA" data-f-datainput="">Georgia</option>
<option value="GU" data-f-datainput="">Guam</option>
<option value="HI" data-f-datainput="">Hawaii</option>
<option value="ID" data-f-datainput="">Idaho</option>
<option value="IL" data-f-datainput="">Illinois</option>
<option value="IN" data-f-datainput="">Indiana</option>
<option value="IA" data-f-datainput="">Iowa</option>
<option value="KS" data-f-datainput="">Kansas</option>
<option value="KY" data-f-datainput="">Kentucky</option>
<option value="LA" data-f-datainput="">Louisiana</option>
<option value="ME" data-f-datainput="">Maine</option>
<option value="MH" data-f-datainput="">Marshall Islands</option>
<option value="MD" data-f-datainput="">Maryland</option>
<option value="MA" data-f-datainput="">Massachusetts</option>
<option value="MI" data-f-datainput="">Michigan</option>
<option value="MN" data-f-datainput="">Minnesota</option>
<option value="MS" data-f-datainput="">Mississippi</option>
<option value="MO" data-f-datainput="">Missouri</option>
<option value="MT" data-f-datainput="">Montana</option>
<option value="NE" data-f-datainput="">Nebraska</option>
<option value="NV" data-f-datainput="">Nevada</option>
<option value="NH" data-f-datainput="">New Hampshire</option>
<option value="NJ" data-f-datainput="">New Jersey</option>
<option value="NM" data-f-datainput="">New Mexico</option>
<option value="NY" data-f-datainput="">New York</option>
<option value="NC" data-f-datainput="">North Carolina</option>
<option value="ND" data-f-datainput="">North Dakota</option>
<option value="OH" data-f-datainput="">Ohio</option>
<option value="OK" data-f-datainput="">Oklahoma</option>
<option value="OR" data-f-datainput="">Oregon</option>
<option value="PW" data-f-datainput="">Palau</option>
<option value="PA" data-f-datainput="">Pennsylvania</option>
<option value="PR" data-f-datainput="">Puerto Rico</option>
<option value="RI" data-f-datainput="">Rhode Island</option>
<option value="SC" data-f-datainput="">South Carolina</option>
<option value="SD" data-f-datainput="">South Dakota</option>
<option value="TN" data-f-datainput="">Tennessee</option>
<option value="TX" data-f-datainput="">Texas</option>
<option value="UT" data-f-datainput="">Utah</option>
<option value="VT" data-f-datainput="">Vermont</option>
<option value="VA" data-f-datainput="">Virginia</option>
<option value="WA" data-f-datainput="">Washington</option>
<option value="WV" data-f-datainput="">West Virginia</option>
<option value="WI" data-f-datainput="">Wisconsin</option>
<option value="WY" data-f-datainput="">Wyoming</option>
</select>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1834" data-f-validationerror="" id="__field_1834_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_1837" data-f-type="textbox"> <label for="9c0e36b0-ee39-4965-ae0d-4e2a5f2d8fee" class="Form__Element__Caption">Patient zip code</label>
<input name="__field_1837" id="9c0e36b0-ee39-4965-ae0d-4e2a5f2d8fee" type="text" class="FormTextbox__Input" aria-describedby="__field_1837_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="postal-code">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1837" data-f-validationerror="" id="__field_1837_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox" data-f-element-name="__field_1838" data-f-type="textbox"> <label for="374c636f-a8cf-4745-83ea-59ac52446818" class="Form__Element__Caption">Email address</label>
<input name="__field_1838" id="374c636f-a8cf-4745-83ea-59ac52446818" type="text" class="FormTextbox__Input" aria-describedby="__field_1838_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="email">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1838" data-f-validationerror="" id="__field_1838_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_31174" data-f-type="textbox"> <label for="5f148d7c-67c9-4f29-8793-f1893a4b477a" class="Form__Element__Caption">Patient Phone Number</label>
<input name="__field_31174" id="5f148d7c-67c9-4f29-8793-f1893a4b477a" type="text" class="FormTextbox__Input" aria-describedby="__field_31174_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="tel">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_31174" data-f-validationerror="" id="__field_31174_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormSelection ValidationRequired" data-f-element-name="__field_29074" data-f-type="selection"> <label for="1ab1b2c3-370c-4625-8f45-793dd50f3113" class="Form__Element__Caption">Phone Type</label>
<select name="__field_29074" id="1ab1b2c3-370c-4625-8f45-793dd50f3113" required="" aria-required="true" data-f-datainput="" aria-describedby="__field_29074_desc" aria-invalid="false" autocomplete="off">
<option disabled="disabled" selected=""selected"" value=""> -- Select an option -- </option>
<option value="Home" data-f-datainput="">Home</option>
<option value="Mobile" data-f-datainput="">Mobile/Cell</option>
<option value="Work" data-f-datainput="">Work</option>
</select>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_29074" data-f-validationerror="" id="__field_29074_desc" role="alert" style="display:none"></span>
</div>
<div aria-invalid="false" class="Form__Element FormChoice hide" data-f-element-name="__field_28062" data-f-type="choice" id="eca58d68-f818-41ed-b531-f5efd3ba4697">
<fieldset aria-describedby="__field_28062_desc">
<legend class="Form__Element__Caption">Do you give permission for Moffitt to text you about your appointment?</legend>
<div>
<input type="radio" id="eca58d68-f818-41ed-b531-f5efd3ba4697_0" name="__field_28062" value="Yes" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="eca58d68-f818-41ed-b531-f5efd3ba4697_0" class="FormChoice__Label"> Yes </label>
</div>
<div>
<input type="radio" id="eca58d68-f818-41ed-b531-f5efd3ba4697_1" name="__field_28062" value="No" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="eca58d68-f818-41ed-b531-f5efd3ba4697_1" class="FormChoice__Label"> No </label>
</div>
</fieldset>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_28062" data-f-validationerror="" id="__field_28062_desc" role="alert" style="display:none"></span>
</div>
</section>
<section id="__field_1842" data-f-type="step" data-f-element-name="__field_1842" class="Form__Element FormStep Form__Element--NonData hide" data-f-stepindex="3" data-f-element-nondata="">
<h3 class="FormStep__Title">Patient Insurance Information</h3>
<aside class="FormStep__Description"></aside>
<!-- Each FormStep groups the elements below it til the next FormStep -->
<div class="Form__Element FormSelection ValidationRequired" data-f-element-name="__field_1847" data-f-type="selection"> <label for="5253ca24-81b2-4be0-96c9-943e40121f7d" class="Form__Element__Caption">Primary insurance</label>
<select name="__field_1847" id="5253ca24-81b2-4be0-96c9-943e40121f7d" required="" aria-required="true" data-f-datainput="" aria-describedby="__field_1847_desc" aria-invalid="false" autocomplete="off">
<option disabled="disabled" selected=""selected"" value=""> -- Select an option -- </option>
<option value="No-Insurance/Self-Pay" data-f-datainput="">No Insurance/Self-Pay</option>
<option value="administrative-concepts" data-f-datainput="">Administrative Concepts, Inc</option>
<option value="Aetna-Better-Health-Florida-Healthy-Kids" data-f-datainput="">Aetna Better Health Florida Healthy Kids</option>
<option value="Aetna-Better-Health-Florida-Medicaid-HMO" data-f-datainput="">Aetna Better Health Florida Medicaid HMO</option>
<option value="Aetna-Commercial-HMO/POS/PPO" data-f-datainput="">Aetna Commercial HMO/POS/PPO</option>
<option value="Aetna-Medicare-Choice-Plan-(POS)" data-f-datainput="">Aetna Medicare Choice Plan (POS)</option>
<option value="Aetna-Medicare-Select-Plan-(HMO)" data-f-datainput="">Aetna Medicare Select Plan (HMO)</option>
<option value="Aetna-Medicare-Premier-Plan-(PPO)" data-f-datainput="">Aetna Medicare Premier Plan (PPO)</option>
<option value="Aetna-Saving-Plus-HMO" data-f-datainput="">Aetna Saving Plus HMO</option>
<option value="AvMed-Commercial-HMO/PPO" data-f-datainput="">AvMed Commercial HMO/PPO</option>
<option value="BCBS-Medicare-HMO/PPO" data-f-datainput="">BCBS Medicare HMO/PPO</option>
<option value="BCBS-Florida-Blue-Federal-Employees-Program-(FEP)" data-f-datainput="">BCBS Florida Blue Federal Employees Program (FEP)</option>
<option value="BCBS-Florida-Blue-PPO-(BLUEOPTIONS)" data-f-datainput="">BCBS Florida Blue PPO (BLUEOPTIONS)</option>
<option value="BCBS-Florida-Blue-PHS-(Traditional)" data-f-datainput="">BCBS Florida Blue PHS (Traditional)</option>
<option value="BCBS-Florida-Blue-PPC-PPO-(BLUECHOICE)" data-f-datainput="">BCBS Florida Blue PPC PPO (BLUECHOICE)</option>
<option value="BCBS-MyBlue-HMO" data-f-datainput="">BCBS MyBlue HMO</option>
<option value="BCBS-Out-of-State-Plans-(BLUECARD)" data-f-datainput="">BCBS Out-of-State Plans (BLUECARD)</option>
<option value="Beech-Street-PPO" data-f-datainput="">Beech Street PPO</option>
<option value="Better-Health-Medicaid-HMO" data-f-datainput="">Better Health Medicaid HMO</option>
<option value="Capital-Health-Plan-(a-BCBS-Affiliate)" data-f-datainput="">Capital Health Plan (a BCBS Affiliate)</option>
<option value="CarePlus-Health-Plan-Medicare-HMO" data-f-datainput="">CarePlus Health Plan Medicare HMO</option>
<option value="ChampVA" data-f-datainput="">ChampVA</option>
<option value="CIGNA-HMO/POS/PPO" data-f-datainput="">CIGNA HMO/POS/PPO</option>
<option value="Cigna/Baycare-Health-System-employee" data-f-datainput="">Cigna/Baycare Health System employee</option>
<option value="Clear-Health-Alliance-Medicaid-HMO" data-f-datainput="">Clear Health Alliance Medicaid HMO</option>
<option value="Coventry-Health-Plan-Commercial-HMO/PPO" data-f-datainput="">Coventry Health Plan Commercial HMO/PPO</option>
<option value="Coventry-Summit-Medicare-HMO" data-f-datainput="">Coventry Summit Medicare HMO</option>
<option value="Devoted-Health-Medicare-HMO" data-f-datainput="">Devoted Health Medicare HMO</option>
<option value="Evolutions-Healthcare-PPO-Prime-and-Select-Networks" data-f-datainput="">Evolutions Healthcare PPO, Prime and Select Networks</option>
<option value="First-Health-PPO" data-f-datainput="">First Health PPO</option>
<option value="Florida-Health-Care-Plan-HMO" data-f-datainput="">Florida Health Care Plan HMO</option>
<option value="Florida-Health-Care-Plan-Medicare-HMO" data-f-datainput="">Florida Health Care Plan Medicare HMO</option>
<option value="Freedom-Heath-Medicare-HMO" data-f-datainput="">Freedom Heath Medicare HMO</option>
<option value="GEHA-Health-Plans" data-f-datainput="">GEHA Health Plans</option>
<option value="Hospice" data-f-datainput="">Hospice</option>
<option value="Gulf-Coast-Provider-Network-PPO" data-f-datainput="">Gulf Coast Provider Network PPO</option>
<option value="Health-First-Health-Plans-Affordable-Care-Plans-all-varieties" data-f-datainput="">Health First Health Plans Affordable Care Plans, all varieties</option>
<option value="Health-First-Health-Plans-Commercial-Plans-all-varieties" data-f-datainput="">Health First Health Plans Commercial Plans, all varieties</option>
<option value="Health-First-Health-Plans-Medicare-Plans-all-varieties" data-f-datainput="">Health First Health Plans Medicare Plans, all varieties</option>
<option value="Hillsborough-County-Health-Care-Plan-(HCHCP)" data-f-datainput="">Hillsborough County Health Care Plan (HCHCP)</option>
<option value="Humana-Commercial-HMO/POS/PPO/EPO" data-f-datainput="">Humana Commercial HMO/POS/PPO/EPO</option>
<option value="Humana-Gold-Plus-Medicare-HMO" data-f-datainput="">Humana Gold Plus Medicare HMO</option>
<option value="Humana-Medicare-PPO-(Choice-PPO) " data-f-datainput="">Humana Medicare PPO (Choice PPO) </option>
<option value="InterLink-CancerCare-Network" data-f-datainput="">InterLink CancerCare Network</option>
<option value="Interplan-PPO" data-f-datainput="">Interplan PPO</option>
<option value="Magellan-Complete-Care-Medicaid-HMO" data-f-datainput="">Magellan Complete Care Medicaid HMO</option>
<option value="Mail-Handlers-Benefit-Plan" data-f-datainput="">Mail Handlers Benefit Plan</option>
<option value="Medica-Health-Plans-Medicare" data-f-datainput="">Medica Health Plans Medicare</option>
<option value="Medicaid" data-f-datainput="">Medicaid</option>
<option value="Medically-Needy" data-f-datainput="">Medically Needy</option>
<option value="Medicare" data-f-datainput="">Medicare</option>
<option value="Meritain-Health " data-f-datainput="">Meritain Health </option>
<option value="Molina-Medicaid-HMO" data-f-datainput="">Molina Medicaid HMO</option>
<option value="MultiPlan-PPO" data-f-datainput="">MultiPlan PPO</option>
<option value="MVP-Healthcare-Commercial-PPO " data-f-datainput="">MVP Healthcare Commercial PPO </option>
<option value="MVP-Healthcare-Medicare-Products" data-f-datainput="">MVP Healthcare Medicare Products</option>
<option value="Neighborhood-Health-Partnership-HMO-(a-United-Healthcare-Plan)" data-f-datainput="">Neighborhood Health Partnership HMO (a United Healthcare Plan)</option>
<option value="Optimum-HealthCare-Medicare-HMO" data-f-datainput="">Optimum HealthCare Medicare HMO</option>
<option value="PHCS-PPO" data-f-datainput="">PHCS PPO</option>
<option value="Quality-Health-Management-PPO" data-f-datainput="">Quality Health Management PPO</option>
<option value="Seminole-Tribe-of-Florida" data-f-datainput="">Seminole Tribe of Florida</option>
<option value="Simply-Healthcare-Plans-Medicare" data-f-datainput="">Simply Healthcare Plans Medicare</option>
<option value="Simply-Healthcare-Medicaid-HMO" data-f-datainput="">Simply Healthcare Medicaid HMO</option>
<option value="Simply-Healthy-Kids" data-f-datainput="">Simply Healthy Kids</option>
<option value="Sunshine-State-Health-Plan-Healthy-Kids" data-f-datainput="">Sunshine State Health Plan Healthy Kids</option>
<option value="Sunshine-State-Health-Plan-Medicaid" data-f-datainput="">Sunshine State Health Plan Medicaid</option>
<option value="Tricare-Prime" data-f-datainput="">Tricare Prime</option>
<option value="TRICARE-Select " data-f-datainput="">TRICARE Select </option>
<option value="Unicare-Commercial" data-f-datainput="">Unicare Commercial</option>
<option value="United-Healthcare-Commercial-HMO/POS/EPO/PPO" data-f-datainput="">United Healthcare Commercial HMO/POS/EPO/PPO</option>
<option value="United-Healthcare-Medicaid-HMO" data-f-datainput="">United healthcare Medicaid HMO</option>
<option value="United-Healthcare-NEXUSACO" data-f-datainput="">United Healthcare NEXUSACO</option>
<option value="United-Healthcare/United-Medicare-Advantage " data-f-datainput="">United Healthcare/United Medicare Advantage </option>
<option value="United-Medical-Resources-(UMR)" data-f-datainput="">United Medical Resources (UMR)</option>
<option value="Veterans-Administration-(VA)-(all-locations)" data-f-datainput="">Veterans Administration (VA) (all locations)</option>
<option value="Volusia-Health-Network-PPO/EPO" data-f-datainput="">Volusia Health Network PPO/EPO</option>
<option value="Web-TPA/Aetna-Signature-Administrators" data-f-datainput="">Web TPA/Aetna Signature Administrators</option>
<option value="Web-TPA/Multiplans" data-f-datainput="">Web TPA/Multiplans</option>
<option value="WellMed-United-Healthcare/United-MCR-Advantage" data-f-datainput="">WellMed United Healthcare/United MCR Advantage</option>
<option value="Zelis-Health" data-f-datainput="">Zelis Health</option>
<option value="Other" data-f-datainput="">Other</option>
</select>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1847" data-f-validationerror="" id="__field_1847_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_1839" data-f-type="textbox"> <label for="f6721ca7-176e-4366-904a-18989aa1977f" class="Form__Element__Caption">Policy ID number</label>
<input name="__field_1839" id="f6721ca7-176e-4366-904a-18989aa1977f" type="text" class="FormTextbox__Input" aria-describedby="__field_1839_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1839" data-f-validationerror="" id="__field_1839_desc" role="alert" style="display:none"></span>
</div>
<div aria-invalid="false" aria-required="true" class="Form__Element FormChoice ValidationRequired" data-f-element-name="__field_1843" data-f-type="choice" id="86d34ab6-247b-42bc-b7f8-6c1a1e57b694" required="">
<fieldset aria-describedby="__field_1843_desc">
<legend class="Form__Element__Caption">Is the patient the policy holder?</legend>
<div>
<input type="radio" id="86d34ab6-247b-42bc-b7f8-6c1a1e57b694_0" name="__field_1843" value="Yes" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="86d34ab6-247b-42bc-b7f8-6c1a1e57b694_0" class="FormChoice__Label"> Yes </label>
</div>
<div>
<input type="radio" id="86d34ab6-247b-42bc-b7f8-6c1a1e57b694_1" name="__field_1843" value="No" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="86d34ab6-247b-42bc-b7f8-6c1a1e57b694_1" class="FormChoice__Label"> No </label>
</div>
</fieldset>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1843" data-f-validationerror="" id="__field_1843_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox hide" data-f-element-name="__field_1844" data-f-type="textbox"> <label for="bf837514-807c-4336-8af5-7df7f7b208cd" class="Form__Element__Caption">Policy Holder's First Name</label>
<input name="__field_1844" id="bf837514-807c-4336-8af5-7df7f7b208cd" type="text" class="FormTextbox__Input" aria-describedby="__field_1844_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1844" data-f-validationerror="" id="__field_1844_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox hide" data-f-element-name="__field_1845" data-f-type="textbox"> <label for="b3765e82-5991-450b-901e-8802aca8d7a0" class="Form__Element__Caption">Policy Holder's Last Name</label>
<input name="__field_1845" id="b3765e82-5991-450b-901e-8802aca8d7a0" type="text" class="FormTextbox__Input" aria-describedby="__field_1845_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1845" data-f-validationerror="" id="__field_1845_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox hide" data-f-element-name="__field_1846" data-f-type="textbox"> <label for="51840c3a-a879-4539-ae34-3bf2391ca4d8" class="Form__Element__Caption">Policy Holder's Date of Birth</label>
<input name="__field_1846" id="51840c3a-a879-4539-ae34-3bf2391ca4d8" type="text" class="FormTextbox__Input" aria-describedby="__field_1846_desc" placeholder="MM/DD/YYYY" data-f-datainput="" aria-invalid="false" autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1846" data-f-validationerror="" id="__field_1846_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormSelection hide" data-f-element-name="__field_1849" data-f-type="selection"> <label for="4d9d6967-27a8-4293-9253-d81fc7fbdfaa" class="Form__Element__Caption">Relationship to the Policy Holder</label>
<select name="__field_1849" id="4d9d6967-27a8-4293-9253-d81fc7fbdfaa" data-f-datainput="" aria-describedby="__field_1849_desc" aria-invalid="false" autocomplete="off">
<option disabled="disabled" selected=""selected"" value=""> -- Select an option -- </option>
<option value="spouse" data-f-datainput="">Spouse</option>
<option value="life-partner" data-f-datainput="">Life Partner</option>
<option value="child" data-f-datainput="">Child</option>
<option value="other" data-f-datainput="">Other</option>
</select>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1849" data-f-validationerror="" id="__field_1849_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox" data-f-element-name="__field_1850" data-f-type="textbox"> <label for="cf8feec8-f604-47ce-8de9-cd9854e38080" class="Form__Element__Caption">Patient's Employer</label>
<input name="__field_1850" id="cf8feec8-f604-47ce-8de9-cd9854e38080" type="text" class="FormTextbox__Input" aria-describedby="__field_1850_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1850" data-f-validationerror="" id="__field_1850_desc" role="alert" style="display:none"></span>
</div>
<div aria-invalid="false" aria-required="true" class="Form__Element FormChoice ValidationRequired" data-f-element-name="__field_1851" data-f-type="choice" id="b59231c0-b16d-44e6-bcca-3e72377e438c" required="">
<fieldset aria-describedby="__field_1851_desc">
<legend class="Form__Element__Caption">Does the patient have secondary insurance?</legend>
<div>
<input type="radio" id="b59231c0-b16d-44e6-bcca-3e72377e438c_0" name="__field_1851" value="Yes" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="b59231c0-b16d-44e6-bcca-3e72377e438c_0" class="FormChoice__Label"> Yes </label>
</div>
<div>
<input type="radio" id="b59231c0-b16d-44e6-bcca-3e72377e438c_1" name="__field_1851" value="No" class="FormChoice__Input FormChoice__Input--Radio" data-f-datainput="">
<label for="b59231c0-b16d-44e6-bcca-3e72377e438c_1" class="FormChoice__Label"> No </label>
</div>
</fieldset>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_1851" data-f-validationerror="" id="__field_1851_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired hide" data-f-element-name="__field_28052" data-f-type="textbox"> <label for="91cf6911-8f49-4f03-9ab1-6311f1fccb33" class="Form__Element__Caption">Secondary insurance plan name</label>
<input name="__field_28052" id="91cf6911-8f49-4f03-9ab1-6311f1fccb33" type="text" class="FormTextbox__Input" aria-describedby="__field_28052_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_28052" data-f-validationerror="" id="__field_28052_desc" role="alert" style="display:none"></span>
</div>
<div class="Form__Element FormTextbox ValidationRequired hide" data-f-element-name="__field_28053" data-f-type="textbox"> <label for="76cf0fa8-9cb5-45a4-b8db-d08e587ff775" class="Form__Element__Caption">Secondary insurance policy number</label>
<input name="__field_28053" id="76cf0fa8-9cb5-45a4-b8db-d08e587ff775" type="text" class="FormTextbox__Input" aria-describedby="__field_28053_desc" placeholder="" required="" aria-required="true" data-f-datainput="" aria-invalid="false"
autocomplete="off">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_28053" data-f-validationerror="" id="__field_28053_desc" role="alert" style="display:none"></span>
</div>
<button id="0d8a2c3b-b5a2-4061-846b-8b5ebd471b69" name="submit" type="submit" value="0d8a2c3b-b5a2-4061-846b-8b5ebd471b69" data-f-is-finalized="false" data-f-is-progressive-submit="true" data-f-type="submitbutton"
data-f-element-name="__field_1467" class="Form__Element FormExcludeDataRebind FormSubmitButton "> Submit</button>
<input name="__field_1863" id="c52e3170-e92e-4c0a-bd28-edf001595646" type="hidden" class="Form__Element FormHidden FormHideInSummarized" data-f-type="hidden">
<input name="__field_1865" id="8aa911a8-0c91-40ac-bd5f-af3fe241d38b" type="hidden" class="Form__Element FormHidden FormHideInSummarized" value="" data-f-type="hidden">
</section>
<nav role="navigation" class="Form__NavigationBar" data-f-type="navigationbar" data-f-element-nondata="">
<button type="submit" name="submit" value="PreviousStep" class="Form__NavigationBar__Action FormExcludeDataRebind btnPrev" data-f-navigation-previous="" disabled=""> Previous step </button>
<div class="Form__NavigationBar__ProgressBar">
<div class="Form__NavigationBar__ProgressBar--Progress" style="width:25%" data-f-navigation-progress=""></div>
<div class="Form__NavigationBar__ProgressBar--Text">
<span class="Form__NavigationBar__ProgressBar__ProgressLabel">Step</span>
<span class="Form__NavigationBar__ProgressBar__CurrentStep" data-f-navigation-currentstep="">1</span>/ <span class="Form__NavigationBar__ProgressBar__StepsCount" data-f-navigation-stepcount="">4</span>
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Physicians and researchers work close together to provide innovative
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Cancer touches all of us. Our mission - to contribute to the prevention
and cure of cancer - depends on your support.
FLORIDA'S TOP CHOICE FOR THE BEST OUTCOMES
Outcomes up to four times the national average.
View our Outcomes
A CANCER CENTER LIKE NO OTHER
RESEARCH. CARE. OUTCOMES.
At Moffitt, ours is an unrelenting mission to save more lives. That’s why we are
accelerating the science with greater urgency than ever before. We are Florida’s
top choice of the best outcomes. For an accurate diagnosis and individualized
treatment plan from the start, choose Moffitt first.
Schedule an Appointment
* 1-888-663-3488
* MyMoffitt Patient Portal
* Find a Doctor
* Patients & Families
MOFFITT IS EXPANDING. JOIN OUR TEAM.
Help Moffitt's 8,000+ employees impact even more lives.
Our newest location, Moffitt Cancer Center McKinley Hospital, is now open.
Moffitt has been named a Top Workplace in Tampa Bay for 12 years in a row. We're
looking for new team members to support our growth across the Tampa Bay region
and beyond with remote opportunities.
Explore Career Opportunities
Planning for Your Care
Moffitt is here to support your cancer care every step of the way. Planning for
personalized care begins even before your first appointment. Here are helpful
resources to help patients and families prepare for appointments and plan for
supporting care throughout treatment.
* Preparing for Your Appointment
* Locations & Directions
* Patient Safety & Visitation Information
* Insurance & Financial Information
* Lodging & Travel Planning
* Programs & Support Services
* Caregivers and Families
Resources for Patients & Families
Search by Cancer Type
Find a list of the conditions and cancers treated at Moffitt.
Cancers We Treat
Where is Moffitt Located?
Moffitt Cancer Center has multiple locations in Florida to deliver the best in
cancer care. With five current locations for patients and a new hospital opening
in July 2023, we continue to grow our space to impact more lives. We are working
to deliver cancer care even closer to where you live with future locations
planned in Southshore, FL and in Pasco County.
Moffitt Cancer Center Magnolia Campus
Located on the USF campus in Tampa, it includes the Moffitt Cancer Hospital,
Muriel Rothman Building (clinic), Vincent A. Stabile Research Building and the
Moffitt Research Center.
Moffitt Cancer Center, Richard M. Schulze Family Foundation Outpatient Center at
McKinley Campus
The Richard M. Schulze Family Foundation Outpatient Center is located less than
a mile from the Magnolia main campus in Tampa, FL.
Moffitt Cancer Center McKinley Hospital
Connect to the McKinley Outpatient Center, Moffitt McKinley Hospital provides
patients with the latest innovations in surgical techniques and inpatient care.
Moffitt Cancer Center at International Plaza
Moffitt Cancer Center at International Plaza is a 50,000-square-foot full
service outpatient facility located near Tampa International Airport.
Moffitt Cancer Center at Wesley Chapel
Moffitt Cancer Center at Wesley Chapel is a 28,000-square-foot outpatient
facility bringing access to Moffitt expertise and cancer care to Pasco County.
Moffitt Malignant Hematology & Cellular Therapy at Memorial Healthcare System
Located in South Florida, the Moffitt Malignant Hematology & Cellular Therapy at
Memorial Healthcare System is a comprehensive Blood and Marrow Transplant
Cellular Therapy Program.
Ready to Request an Appointment? Complete the online appointment request form.
Start Appointment Request
THE END OF CANCER BEGINS HERE®
We don't just deliver innovative cancer treatments. We invent them. Physicians
and researchers within Moffitt work closely together to provide innovative
treatment options. Our patients have access to more than 350 clinical trials at
Moffitt.
Find a Clinical Trial
MORE THAN CANCER CARE FROM MOFFITT
Treating cancer is what we do. But more than the latest treatment options, we
are also committed to cancer prevention, cancer screenings for early detection,
and a range of diagnostic services for cancer and other conditions.
Diagnostic Services
Moffitt offers the latest procedures, utilizing the most advanced technology for
screening, diagnosis, intervention and surveillance of cancer.
Cancer Screenings
Screening tests increase the chance of detecting certain cancers early, when
there are more treatment options available. Explore Moffitt’s screening
services.
Breast Tomosynthesis (3D Mammography)
Digital tomosynthesis, or 3D mammography, is an advanced imaging test that is
used to detect breast cancer.
Lung Cancer Screening and Surveillance Program
You may develop lung cancer and not know. A lung cancer screening could save
your life.
PATIENT SATISFACTION RATING
4.9 out of 5
58100
Reviews
Learn more about patient satisfaction surveys
FIND A DOCTOR
Cancer Type Select No Preference Adrenal Carcinoma Anal Cancer Appendiceal
(Appendix) Cancer Astrocytoma Basal Cell Carcinoma Bladder Cancer Brain Cancer
Breast Cancer Cervical Cancer Cholangiocarcinoma (Bile Duct Cancer) Colon Cancer
Colorectal Cancer Cutaneous Lymphoma (CTCL) Ductal Carcinoma In Situ Endometrial
(Uterine) Cancer Esophageal Cancer Gallbladder Cancer Gastrointestinal Carcinoid
Tumor GIST (Gastrointestinal Stromal Tumor) Glioblastoma Head and Neck Cancer
Her 2 positive Hodgkin Lymphoma Inflammatory Breast Cancer Invasive Ductal
Carcinoma Kidney (Renal Cell) Cancer Leukemia Liver Cancer Lung Cancer Melanoma
Meningioma Merkel Cell Carcinoma Mesothelioma Metastatic Breast Cancer Multiple
Myeloma-Plasma Cell Tumor Myelodysplastic Syndromes (MDS) Neuroendocrine Tumor
Neurofibromatosis Non-Hodgkin Lymphoma Oral Cavity or Throat Cancer Osteosarcoma
Ovarian Cancer Pancoast Tumor Pancreatic Cancer Penile Cancer Pituitary Adenoma
Prostate Cancer Rectal Cancer Sarcoma Skin Cancer (Nonmelanoma) Small Intestine
Cancer Spinal Tumor Squamous Cell Carcinoma Stomach (Gastric) Cancer Testicular
Cancer Thymoma Thyroid Cancer Triple Negative Breast Cancer Vaginal Cancer
Vulvar Cancer
Specialty Select No Preference Anesthesiology Cardiology Clinical Psychology
Dermatology Endocrinology Family Medicine Gastroenterology Genetics Gynecologic
Oncology Head and Neck Surgery Hematology Hematology/Oncology Hospice &
Palliative Medicine Infectious Diseases Internal Medicine Interventional
Radiology Medical Oncology Neuro Oncology Neurology Neurosurgery Otolaryngology
Pain Medicine Pathology Plastic Surgery Psychiatry Pulmonology Radiation
Oncology Radiology Surgery Thoracic Surgery Urology
Location Select Moffitt Cancer Center, Magnolia Campus Moffitt Cancer Center at
International Plaza Moffitt Cancer Center, Richard M. Schulze Family Foundation
Outpatient Center at McKinley Campus Moffitt Cancer Center at Wesley Chapel
Gender Select No Preference Male Female
Department or Program Select No Preference Adolescent Young Adult Anesthesiology
Blood and Marrow Transplant and Cellular Immunotherapy Breast Oncology Cutaneous
Oncology Diagnostic Imaging and Interventional Radiology Endocrine Oncology
Gastrointestinal Oncology Genetics Genitourinary Oncology Gynecologic Oncology
Head and Neck Oncology Head and Neck-Endocrine Oncology Individualized Cancer
Management Infectious Diseases Internal & Hospital Medicine Internal Medicine
Malignant Hematology Malignant Hematology and Cellular Therapy at Memorial
Healthcare System Neuro-Oncology Pathology Radiation Oncology Sarcoma Senior
Adult Oncology Supportive Care Medicine Thoracic Oncology
Keywords
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Registration Now Open!
MILES FOR MOFFITT
Join us Saturday, Nov 18 in downtown Tampa for our 18th annual event
Register Now Learn More
DONATE
Because of the generosity of donors and our volunteers, countless patients can
now call themselves cancer survivors. We’re all in this fight together, and we’d
be honored to have your support.
Ways to Give
Cancer touches all of us. Our mission - to contribute to the prevention and cure
of cancer - depends on your support.
Volunteer Your Time
Moffitt volunteers provide comfort and hope to our patients when they need it
most.
MOFFITT MAKING HEADLINES
Top news stories from around Moffitt.
View All News Stories
Moffitt Cancer Center a Best and Brightest Company to Work For in the Nation for
the 7th Year in a Row
Cancer center also highlighted as Top 101 Highest Scoring Companies in the
Nation
Moffitt Cancer Center at Port Tampa Bay Offers Community Outreach and Education
New downtown Tampa facility will focus on cancer prevention, education,
screenings and early detection
Moffitt Cancer Center Launches New Corporations and Board for SPEROS FL
Moffitt Lifesciences Campus Management Corporation, Moffitt Real Estate Holding
Corporation and four-person board will guide progress
Cell Therapy Milestone: Moffitt has treated its 1,000th patient with chimeric
antigen receptor T-cell therapy, or CAR T.
Patient story
What Our Patients Say About Moffitt
I knew Moffitt was where I needed to be to live. Once I was in Moffitt, I knew I
would survive.
Cathy - Advanced Colon Cancer Survivor
I came out as a winner. My daughters know that their father never quit.
Dimas - Non-Hodgkin Lymphoma Survivor
They got me back on the tennis courts and back in the swimming pool and I'm ever
so grateful.
Wilbur - Thyroid Cancer Survivor
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. A member of
our Patient Access team will contact you to schedule an appointment.
APPOINTMENT DETAILS
What best describes your first appointment at Moffitt?
A cancer concern or suspected diagnosis
Exploring cancer treatment options
Interest in a clinical trial
Screening, genetic testing or survivorship exams
Have you received a diagnosis of cancer? -- Select an option -- No Diagnosis
Newly Diagnosed Currently in Treatment Recurrence
What is the known or suspected cancer type? Please select No Diagnosis or
Unknown Adrenal Carcinoma Adrenal Nodules/Adrenal Mass Anal Cancer Appendiceal
(Appendix) Cancer Basal Cell Carcinoma Bladder Cancer Brain Cancer Breast Cancer
Breast Cancer - Ductal Carcinoma In Situ Breast Cancer - Inflammatory Breast
Cancer - Invasive Ductal Carcinoma Breast Cancer - Triple Negative Cervical
Cancer Cholangiocarcinoma (Bile Duct Cancer) Colon Cancer Colorectal Cancer
Esophageal Cancer Gallbladder Cancer Gastrointestinal Carcinoid Tumor GIST(GI
Stromal Tumor) Glioblastoma Head and Neck Cancer Kidney (Renal Cell) Cancer
Leukemia Liver Cancer Lung Cancer Lymphoma Lymphoma - Hodgkin Lymphoma -
Non-Hodgkin Melanoma Meningioma Merkel Cell Carcinoma Mesothelioma Multiple
Myeloma-Plasma Cell Tumor Myelodysplastic Syndromes (MDS) Neuroendocrine Tumor
Neurofibromatosis Oral Cavity or Throat Cancer Osteosarcoma Ovarian Cancer
Pancoast Tumor Pancreatic Cancer Penile Cancer Pituitary Adenoma Prostate Cancer
Rectal Cancer Sarcoma Skin Cancer Small Intestine Cancer Spinal Tumor Squamous
Cell Carcinoma Stomach (Gastric) Cancer Testicular Cancer Thymoma Thyroid Cancer
Thyroid Nodules Vaginal Cancer Vulvar Cancer Other
Please explain the known or suspected cancer type
Are you interested in learning about clinical trials at Moffitt?
Yes I would
Not at this time
What type of screening or exam are you seeking? -- Select an option -- Annual
Mammogram Colonoscopy Genetic Counseling Lung Screening Other Survivorship Exam
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I am referring myself
I am being referred by my physician
I am being referred by my employer
What is the name of the physician who is referring you?
APPOINTMENT PREFERENCES
Do you have a preferred Moffitt location?
First Available
Magnolia campus, 12902 USF Magnolia Drive, Tampa
McKinley clinic, 10920 N. McKinley Drive, Tampa
International Plaza, 4101 Jim Walter Blvd., Tampa
Wesley Chapel, 2590 Healing Way, Wesley Chapel
Virtual (only available if patient is in Florida)
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Yes
No
Please enter the name of the Moffitt provider you would like to see.
PATIENT CONTACT INFORMATION
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PATIENT INSURANCE INFORMATION
Primary insurance -- Select an option -- No Insurance/Self-Pay Administrative
Concepts, Inc Aetna Better Health Florida Healthy Kids Aetna Better Health
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(POS) Aetna Medicare Select Plan (HMO) Aetna Medicare Premier Plan (PPO) Aetna
Saving Plus HMO AvMed Commercial HMO/PPO BCBS Medicare HMO/PPO BCBS Florida Blue
Federal Employees Program (FEP) BCBS Florida Blue PPO (BLUEOPTIONS) BCBS Florida
Blue PHS (Traditional) BCBS Florida Blue PPC PPO (BLUECHOICE) BCBS MyBlue HMO
BCBS Out-of-State Plans (BLUECARD) Beech Street PPO Better Health Medicaid HMO
Capital Health Plan (a BCBS Affiliate) CarePlus Health Plan Medicare HMO ChampVA
CIGNA HMO/POS/PPO Cigna/Baycare Health System employee Clear Health Alliance
Medicaid HMO Coventry Health Plan Commercial HMO/PPO Coventry Summit Medicare
HMO Devoted Health Medicare HMO Evolutions Healthcare PPO, Prime and Select
Networks First Health PPO Florida Health Care Plan HMO Florida Health Care Plan
Medicare HMO Freedom Heath Medicare HMO GEHA Health Plans Hospice Gulf Coast
Provider Network PPO Health First Health Plans Affordable Care Plans, all
varieties Health First Health Plans Commercial Plans, all varieties Health First
Health Plans Medicare Plans, all varieties Hillsborough County Health Care Plan
(HCHCP) Humana Commercial HMO/POS/PPO/EPO Humana Gold Plus Medicare HMO Humana
Medicare PPO (Choice PPO) InterLink CancerCare Network Interplan PPO Magellan
Complete Care Medicaid HMO Mail Handlers Benefit Plan Medica Health Plans
Medicare Medicaid Medically Needy Medicare Meritain Health Molina Medicaid HMO
MultiPlan PPO MVP Healthcare Commercial PPO MVP Healthcare Medicare Products
Neighborhood Health Partnership HMO (a United Healthcare Plan) Optimum
HealthCare Medicare HMO PHCS PPO Quality Health Management PPO Seminole Tribe of
Florida Simply Healthcare Plans Medicare Simply Healthcare Medicaid HMO Simply
Healthy Kids Sunshine State Health Plan Healthy Kids Sunshine State Health Plan
Medicaid Tricare Prime TRICARE Select Unicare Commercial United Healthcare
Commercial HMO/POS/EPO/PPO United healthcare Medicaid HMO United Healthcare
NEXUSACO United Healthcare/United Medicare Advantage United Medical Resources
(UMR) Veterans Administration (VA) (all locations) Volusia Health Network
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Healthcare/United MCR Advantage Zelis Health Other
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Shared Resources
* Analytic Microscopy
* Biostatistics and Bioinformatics
* Cancer Pharmacokinetics and Pharmacodynamics
* Cell Therapies
* Chemical Biology
* Collaborative Data Services
* Flow Cytometry
* Gene Targeting
* Molecular Genomics
* Participant Research, Interventions, and Measurement Core (PRISM)
* Proteomics and Metabolomics
* Quantitative Imaging Core
* Small Animal Imaging Lab
* Tissue
Community Outreach, Engagement, and Equity
* About Us
* Research in the Community
* Get Involved
* Catchment Area Cancer Data
* Education and Outreach Resources
* Moffitt Outreach in the Community
Academic and Industry Partnerships
* Office of Innovation
* Academic Partnerships
Training & Education
* Education
* Medical Education
* Research Education and Training
* Nursing Education
* Health Professional Education
* Other Educational Programs
Medical Education
* Our Training Programs
* Program Staff/Contact Us
* Salary and Benefits
* Diversity in Training and Education
* About Tampa Bay
Research Education and Training
* Office of Postdoctoral Affairs
* Office of Graduate Affairs
* Office of Undergraduate and Visiting Scholar Affairs
* What We Provide
* News
* Contact Us
* Diversity in Training and Education
* About Tampa Bay
Nursing Education
* Ambulatory Care Oncology Nurse Residency Program
* Nurse Anesthetist
* Nurse Practitioner
* Oncology Nurse Residency Program
* Registered Nurse
Give
* Give
* Why Give?
* Ways to Give
* Get Involved
Why Give?
* About the Moffitt Foundation
* FAQ
* Financials and Stewardship
* Contact the Foundation
* You Can Make a Difference
* Impact Report
Ways to Give
* Cash, Stock or Other Assets
* Planned Giving
* Philanthropic Foundation Giving
* Corporate Partnership
* Employer Matching Gifts
* Endowment Gifts
* Other Ways to Donate
* Breast Cancer Funding Opportunities
* Support the Pentecost Family Myeloma Research Center
Get Involved
* Become a Member
* Join a Community Partner Event
* Volunteer Your Time
* Miles for Moffitt
* Magnolia
* Mission Possible Sarasota Luncheon
* Discovery Series Webinars