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3000 Medical Park Dr.
Suite 140
Tampa, FL 33613
Phone: 813-793-4272
Fax: 813-374-9495
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Patient Forms
The USF Breast Health Program has many on-line forms available to help collect your important data. Please click on any of the following links to complete a specific form. You may then print the form to bring with you to your clinic visit, or you may email it to the USF Breast Health Program.
Patient Data | |
| Patient Questionnaire (English) | Adobe Acrobat version (PDF) |
| Patient Questionnaire (Spanish) | Adobe Acrobat version (PDF) |
| Patient Questionnaire (English) | Coming Soon...on-line version |
| Patient Questionnaire (Spanish) | Coming Soon...on-line version |
| Breast Cancer Risk Assessment | Adobe Acrobat version (PDF) |
Surgery | |
| TBA | |
Medical Records | |
| Medical Records Release | Adobe Acrobat version (PDF) |
Insurance | |
| TBA | |
| TBA | |
Research | |
| Breast Care Database Consent (English) | |
| Breast Care Database Consent (Spanish) | |
Please note: You will need Adobe Acrobat Reader to view and download these forms. If it is not already installed on your computer, you may download it by clicking here:
USF Breast News
Charles E. Cox Recently Recognized by Srathmore's Who's Who Publication
January, 2012, Westbury, N.Y.
Charles Cox, M.D., has recently been recognized as a Professional of the Year by Strathmore's Who's Who Registry
for his outstanding contributions and achievments in the field of Surgical Oncology...
Tampa Bay Business Journal awards Dr. Cox Lifetime Achievment
10/14/2011 7:23:21 AM
The Tampa Bay Business Journal announced the winners of the 2011 Health Care Heroes awards.
Dr. Charles Cox took home the Lifetime Achievement Award...
Linda Hurtado, Health Reporter for ABC Action News, Tampa,
personal experience with breast cancer
10/11/2011 5:50 PM
ABC Action News Health
Reporter, Linda Hurtado, has shared a very personal experience
dealing with her recent diagnosis of breast cancer. She shared
this news on a live broadcast which aired at 5:50 PM, Tuesday,
October 11, 2011.
More news...