Refer a Patient: Forms
Make a Referral with Ease
At Specialty Infusion Center, we make it simple for providers to connect their patients to the infusion therapies they need. Our referral forms are organized so you can quickly find the right one, complete it, and fax it with the required documentation to our team.
Fax completed referrals and documentation to 855-857-3834
If you have any questions, our referral support team is here to help at 989-619-6253.
Referral Instructions (Reminder)
- Select the appropriate referral form.
- Complete the form with required patient and provider details.
- Fax the form and all corresponding paperwork as indicated.
- Our team will confirm receipt and contact you with any questions.
