Questions, please call USF Health at (813)974-2201 and we would be happy to assist you.   
Thank you for using our online appointment request service. By taking a few minutes to complete this form, you–or your healthcare representative acting on your behalf–can request an appointment with a USF Health specialist. To expedite your request, please provide as much information below as you can. Because we value your privacy, your personal information will not be used by us other than to schedule an appointment.

We will contact you within 24-hours with information. If you submit your request on a holiday or Friday afternoon through Sunday, we will respond by the end of the next business day. If you do not hear from us within this timeframe, have questions, or prefer to make an appointment by phone, please call USF Health at (813)974-2201 and we would be happy to assist you.

*Required fields.

Personal Information
*First Name:
Middle Name/Initial:
*Last Name:
*Date of Birth:
*Email:
*Preferred Phone No.:
Extension:
*How did you find us?
Physician Name:

Appointment Information
*Specialty:
 
***A scheduler will contact you to secure your appointment.
 
*Preferred Provider:
No Preference