How to Make a Referral

Making a patient referral for infusion therapy is simple. To refer a patient, follow these three steps:
Step 1: Download the therapy-specific order form, from the list below.
Step 2: Complete the order form.
Step 3: Fax the completed order form to 507-389-8691.   Please make sure you include the patient’s details, including:

  • Full contact information.
  • Insurance information
  • Diagnosis with supporting documentation

After receiving the above information, we will contact the patient to schedule an appointment, once pre-determination has been completed.

Infusion Therapy Order Forms
Please find our therapy-specific forms below. To inquire about a specific therapy not listed below, please contact us at 507-389-8513. We can also email or fax forms directly to your office.