How to Refer a Patient

Non-Transplant

To refer a patient to a Tampa General Medical Group (TGMG) specialist, please complete one of the following referral forms below (differs by specialty):

Please fax the requested information detailed within the referral forms to the fax numbers listed at the bottom of the form. To expedite your request, please provide as much information as you can. Should you have any questions or concerns, please do not hesitate to contact the TGMG case managers by calling (813) 844-5507. 

Heart/VAD Transplant

To refer a patient for heart/ventricular assist device (VAD) transplant consideration, please fax the pertinent medical information (medical history, recent treatment, list of medications, current lab work and copy of insurance card) to (813) 844-4179 . To expedite your request, please provide as much information as you can. Should you have any questions or concerns please do not hesitate to contact the transplant referral coordinator at (813) 844-4088.

Click here for the Cardiothoracic Transplant Referral Form.

Kidney/Pancreas/Liver Transplant

To refer a patient for kidney/pancreas/liver transplant consideration, please fax the pertinent medical information (medical history, recent treatment, list of  medications, current lab work and copy of insurance card) to (813) 844-1655. To expedite your request, please provide as much information as you can. Should you have any questions or concerns, please do not hesitate to contact the transplant referral coordinator by calling (813) 844-8686.

Click here for the Liver Transplant Referral Form.

Click here for the Kidney and Pancreas Transplant Referral Form.

For information about other TGH transplant programs call (800) 844-9302.

Interpretation Services Available: Sign language or foreign language interpretation services are available.