for providers
- HOME
- FOR PROVIDERS
REFER YOUR PATIENT TO US
OPTION 1
Find your requested infusion treatment below and click “FILL AND SIGN” to complete our Google order form online. Easily upload patient labs / insurance information and click SUBMIT!
OPTION 2
Find your requested infusion treatment below and click “DOWNLOAD FORM.” Complete the order form and fax it back to us with patient labs / insurance information. Fax Number: 972-810-0994
NEXT STEPS
After we receive the order form and patient information, we will handle all other details involving the patient’s infusion therapy treatment.
FOLLOW-UP
We will keep you and your office updated on the patient’s status throughout the insurance approval process and during /after the course of infusion treatment.
MEDICAL INFUSION THERAPY ORDER FORMS
Our therapy-specific order forms are below. Please note that we routinely update our forms to comply with new insurance requirements. To inquire about a specific therapy not listed below, please feel free to contact us or complete a blank order form. We can also email, fax or deliver forms directly to your office!
INFUSION ORDER
IV HYDRATION ORDER
IV ANTIBIOTIC ORDER
IVIG INFUSION ORDER
IV IRON ORDER
IV SOLUMEDROL ORDER
PROLIA ORDER
EVENITY ORDER
