For Providers
Simplifying The Process For Complex Therapies
Kindly fax the patient's demographics, most recent office note recommending the appropriate medication along with the completed referral form below and we'll do the rest. Fax to: (770) 618-9617
Referral Forms For Download
- Briumvi™
- Entyvio®
- Gastroenterology Referral Form
- General Order Form
- Infliximab and biosimilars
- IVIG (for Primary Humoral Immunodeficiencies)
- Neurology Referral Form
- Ocrevus®
- Ocrevus Zunovo™
- Rheumatology Referral Form
- Skyrizi®
- Stelara®
- Tepezza® (Teprotumumab)
- Tremfya®
- Tysabri® (For Crohn's Disease)
- Tysabri® (For Multiple Sclerosis)
- Ultomiris®
- Uplizna®
- Vyepti®
- Vyvgart®
- Vyvgart® Hytrulo