• Referred To Specific Physician
  • Patient Information (All Fields Required)
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  • Referring Physician Information
  • Primary Care Physician Information
  • Primary Insurance
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  • Secondary Insurance
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  • Faxed referrals or records can be sent to 813-844-5763 or emailed to HVIheartfailurereferral@tgh.org. Referrals can be called in to 813-844-5905.


    *Mail Films to: TGH/Transplant Services HMT 5th Floor P.O. BOX 1289, Tampa, FL 33601

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