Scheduling:
(813) 24- TOWER (8-6937)
Medical Records:
(813) 875-7424
Billing:
(813) 253-2721 ext. 0
* Indicates Required Field
Patient's First Name:*
Patient's Middle Initial:
Patient's Last Name:*
Date of Birth:*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Preferred Phone Number for Tower to Contact:*
-
-
Ordering Doctor:*
FAX Exam Appointment Confirmation to:*
-
-
Exam That Needs to be Scheduled:*
Select Exam
MRI
Weight-Bearing Open MRI
Extremity Open MRI
Open MRI
MR Angiography
MRI Arthrogram
Cardiac MRI
CT
CT Angiography
PET/CT Exam
Nuclear Medicine Exam
CT Myelogram
Steroid Joint Injection/Pain Relief
Screening Digital Mammogram
Diagnostic Digital Mammogram
3D Tomosynthesis Mammography
Breast MRI
Breast Biopsy
Ultrasound
Vascular Ultrasound
Breast Ultrasound
Bone Density/DEXA
Nuclear Stress Test
Echocardiogram
Body Composition
Heart Screening
Lung Screening
Cardiac MRI
Prostate MRI
X-Ray - Walk-in Service (No appointment necessary)
Comments:
FAX Exam Prescription & Authorization to: (813) 879-1809
Feel free to call our scheduling department at (813) 874-3177
All appointment request form submissions are answered within 24 hours or next business day; this form should not be used for emergency or urgent needs. If you have an emergency you should call 911. All electronic mail is, by its nature, not secure, and no health information should be included. If you have medical information that needs to be provided to Tower Radiology Centers, please call the office directly (813) 874-3177 or fax information to (813) 879-1809.
© 2021 Tower Imaging, LLC
About Us
|
Contact Us
|
Related Links
Press Releases
|
Teleradiology
Privacy Policy
Schedule Online
Patient Survey