Call for an appointment:

813-570-6971

Mon-Fri 8am-5pm

Empowering Healthy Lives

Forms

Medical Records Release Form Download

  • New Patients

    To switch to Dr. Jacobson: download, fill out and send the completed Medical Records Release Form above to your previous physician.

  • Existing Patients

    To stay with Dr. Jacobson: download, fill out and send the completed Medical Records Release Form above to our new office. You can fax it to us at 813-570-6977.


Other Forms

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New Office Location

New Office Location

Dr. Jacobson has moved to a new office conveniently located on Northdale Blvd next to Whole Foods and across from the Bob Sierra YMCA.

Get Directions