Submit a Referral
Email: orders@flexcareinfusion.com
Fax: (888) 219-8102
Download our convenient fillable PDF referral forms for a specific condition or medication below, then simply fax or email to our office along with the necessary patient documentation. We’ll take care of verifying the patient’s insurance coverage and working through the prior authorization process if needed.
Click on the name of the drug or condition below to download the PDF referral form. Use the search bar to search our list of referral forms.
Search for forms by drug name
Search for forms by condition
FlexCare Infusion Protocol
Please click on any box below to download the protocol PDF document.
Acute Infusion Reaction & Anaphylaxis Treatment Protocol
Flushing and Locking Protocols
Infliximab (including biosimilars) Dose Rounding Protocol
Need a different form? We’re here to help!
If you would like to see a referral form that is not listed above, please contact us.