If seeking another MRI, CT, Nuclear Medicine or PET/CT Facility:

• Does my alternative to TOWER offer Board Certified Radiologists who Sub-specialize in Neuroradiology,
  Musculoskeletal (Orthopedic) Imaging, Body Imaging, Nuclear Medicine, Pediatric Radiology, Women's Imaging, 
  Vascular & Interventional Radiology and Cardiothoracic Imaging?
• Does my alternative to TOWER offer Board Certified Radiologists who have qualified and received a
  Certificate of Added Qualification in Neuroradiology, Vascular & Interventional Radiology and Pediatric
  Radiology?
• Does my provider offer a dedicated team of radiologists who are Diplomates of the American Board
  of Nuclear Medicine? 
• Does my provider dedicate a team of radiologist to read Breast MRI exams who sub-specialize
  in Breast Imaging?
• Does my provider utilize Computer Aided Detection (CAD) when interpretating Breast MRI exams?
• Has my alternative to TOWER received accreditation through the American College of Radiology and ICAEL?

If seeking another Mammogram, Ultrasound, Breast MRI, Breast Biopsy Facility:

• Does my alternative to TOWER have a dedicated team of women's imaging radiologists who are fellowship trained?
• Is my alternative to TOWER an accredited Breast Imaging Center of Excellence through the
  American College of Radiology?
• Does my provider have a dedicated team of board-certified radiologist who specialize
  Mammography and breast biopsy?
• Does my provider dedicate a team of radiologist to read Breast MRI exams who sub-specialize
  in Breast Imaging?
• Does my provider offer Breast MRI with Computer Aided Detection (CAD)?
• Does my alternative mammography center use Digital Mammography?
• Does my provider have the experience of reading more than 5,000 mammograms each year?
• Does my provider offer Stereotactic and MRI-guided Breast Biopsy?

AT TOWER, Our Mission is to provide the highest quality of screening, diagnostic and interventional radiology services to both patients and providers in our community within a safe, compassionate, professional and technologically advanced environment.

We look forward to serving you and your families radiology needs.

CD printing fees:

• There will be a $5 fee for each CD requested by a patient

HEALTH SAVINGS ACCOUNT (HSA) & FLEX SPENDING ACCOUNT (FSA) PAYMENTS ACCEPTED

We accept the following credit cards:

Please complete the following form to request a copy of your medical records. 

Note: Please allow 24 hours from next business day for CD to be ready for pick up. 

**As of Monday, October 2nd, there will be a $5 fee for each CD requested by a patient**

* Indicates Required Field
*First Name:
*Middle Initial:
*Last Name:
*Date of Birth:
Phone Number:
*Email Address:
Physician Requesting Exam:
Requested Exam(s):	Exam* Date of Service* 1. Report Only Report & CD 2. Report Only Report & CD 3. Report Only Report & CD
Pickup Location:*	Please Select Tower Breast Diagnostic - Habana Tower Breast Diagnostic - Northside Tower Radiology – Bayonet Point Tower Radiology – Bloomingdale Tower Radiology - Bruce B. Downs Tower Radiology - Carrollwood Tower Radiology - Habana Tower Radiology – New Port Richey Tower Radiology – New Tampa Tower Radiology - North Dale Mabry Tower Radiology – Oldsmar Tower Radiology – Parsons Tower Radiology - Riverview Tower Radiology - Robertson Tower Radiology - South Tampa Tower Radiology – Sun City Tower Radiology – Trinity Tower Radiology - Wesley Chapel
Preferred Pickup Date:*	Please Provide 24 hour notice
Preferred Pickup Time:*	AM PM
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