Contact Us...
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 Instructions (English) | Adobe Acrobat version (PDF) |
| 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
Florida Hospital and USF Health Form Partnership in Key
Specialties to Expand Translational Medicine in Tampa bay
03/12/2012 Tampa, FL
Florida Hospital and USF Health have formed a
strategic alliance, combining Adventist Health System's
innovative approach to patient-centered care with the University
of South Florida's leading research...
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...
More news...