REFER A PATIENT

EASY REFERRAL PROCESS

Simply complete the appropriate referral form and send it to us via your preferred method from the options at the bottom of the referral form. Our care team will handle the rest, including those pesky insurance verifications.

Questions? Call 212.776.9090

Actemra® Adakveo@ Amvuttra® Apretude Aralast® Avsola® Benlysta® Boniva® Briumvi® Cerezyme® Cimzia® Cinqair® Cinryze® Crysvita® Elaprase Entyvio® Evenity® Fabrazyme® Fasenra® Givlaari® Glassia Hydration Ilaris® Ilumya® Infliximab® Intralipid® IVIG Keytrada® Krystexxa® Lemtrada® Leqembi® Leqvio® Lumizyme® Nexviazyme® Nucala® Nulojix® Ocrevus® Onpattro® Opdivo® Opdivo® with Yervoy® Opdualag® Orencia® Prolastin®-C Qutenza® Remicade® Renflexis® Rituxan® OR Biosimilar Ruxience® Rystiggo® Saphnelo® Simponi Aria® Skyrizi® Soliris® Solu-Medrol® Spevigo® Stelara® Tepezza® Tezspire® Thyrogen® Truxima® Tysabri® Ultomiris® Uplinza® Vitamin Therapy Vyepti® Vyvgart® Vyvgart®-Hytrulo Xolair® Yervoy® Zemaira® Zoledronic Acid
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Required Information Checklist

Clinical Records

  • Diagnosis Code/Date of Diagnosis
  • Height/Weight
  • History of Treatment
  • Failed Medications/Therapies
  • Previous Lab Work (Date of Last TB Test/HBV Test)
  • Any Other Pertinent Information supporting Patient’s Treatment Plan

Patient Information

  • Full Legal Name
  • Email and Phone Number
  • DOB
  • Address
  • Insurance Card (Front and Back)