Moffitt Clinical Pathways Account Request Form

To get started, please complete and submit the form below. Once received, a representative from our Physician Access Line (PAL) will reach out to you to complete the process. If you have any questions, please call Moffitt’s Physician Access Line at 1-888-Moffitt (1-888-663-3488), Option 1.

Already have an account? If yes, please proceed to the Moffitt Clinical Pathways site login page.       Forgot Password?

Physician Information
Items marked with * are required
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Yes: No:
Occupation
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Primary Address and Telephone Number






5-digits, numbers only *

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Area Code Phone Number
(No dash, numbers only)

E-mail Address Information
*