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Office: 360-933-4892 | Fax: 360-933-1197

Download Order Forms
To send a patient referral:

Download, fill, and sign order. Include supporting clinicals as needed. Fax to (360) 933–1197.

How It Works

General Order Form

Use this form if no therapy-specific form applies.

Infusion Therapy Order Form

Infusion Therapies

Dihydroergotamine (DHE) Referral Form
Enteral Order Form
Enteral Checklist
Hyperemesis (Hydration and Antiemetics) Order Form
Intradialytic Parenteral Nutrition (IDPN) Order Form
Intrathecal Pump Order Form
IV Antibiotic Order Form
Iron Order Form
Methylprednisolone (Solu-Medrol) Order Form
Octreotide Order Form
Patient Controlled Analgesia (PCA) Order Form
Total Parenteral Nutrition (TPN) Order Form
Zoledronic Acid (Reclast) Order Form

Specialty Biologics

Benlysta Order Form
Briumvi Order Form
Cosentyx Order form
Entyvio Order Form
Glassia Order Form
Imaavy Order Form
Immune Globulin (IV) Order Form
Immune Globulin (sub-Q) Order Form
Infliximab Order Form

Specialty Biologics

Ocrevus Order Form
Prolia Order Form
Rebyota Order Form
Rituximab and Biosimilars Order Form
Skyrizi Order Form
Stelara (for Crohns or UC) Order Form
Stelara (for Psoriasis) Order Form
Tysabri Order Form
Vyepti Order Form
Vyvgart Order Form
Vyvgart Hytrulo Order Form

Make a Referral

At Infusion Solutions, we want to make referrals as simple as possible for the entire healthcare team. 

How it works:  

 Send us a completed referral order:  

  • Signed order form 
  • Supporting clinicals 
Secure Document Upload

We take care of the rest:  

  • Prior authorization with patient’s insurance 
  • Financial assistance & counseling 
  • Clinical review by our expert pharmacy staff 
  • Patient scheduling 
  • Wonderful patient infusion experience 
  • Continued clinical follow up 
  • Transparency and updates throughout the process for your office 

Providers