MedRx Infusion

Quick Referral
Quick Referral

Quick Referral

Referring Your Patient is Easy!
Patients can quickly and easily be referred by one of the options below. Once your referral is received, an Intake Coordinator will contact you to complete the process.

Call our toll free number (844) 671-2600 to speak with one of Medrx Infusion intake coordinators.

Referral Forms can be downloaded, completed and faxed to MedRx at (844) 671-2601

Note: Faxed prescriptions can only be accepted from the prescribing practitioner. If you are using the Fax Referral Form to self-refer to MedRx Infusion, a physician’s signature and original prescription drug order are required. If materials include Protected Health Information (PHI), MedRx Infusion will maintain strict adherence to HIPAA Privacy guidelines.

DOWNLOAD REFERRAL FORMS:

Immunoglobulin Referral Form

Neurology Referral Form

Multiple Sclerosis Referral Form

Migraine Referral Form

Migraine Referral Form

Allergy and Asthma Referral Form

Hepatitis C Referral Form

Hepatitis B Referral Form

Rheumatology Referral Form

Osteoporosis Referral Form

Nephrology Referral Form

Oncology Referral Form

Iron Infusion Referral Form

Hemophilia Referral Form

Dermatology Referral Form