Refer A Patient

To refer a patient, please send us an order form or a prescription including the required information listed below. Once the form is completed, you can upload the information online or fax it to 800-540-1852.
e-Prescriptions are accepted.

E-Prescribe: (347) 691 – 3494
QuickRx Specialty Pharmacy
1642 Eastchester Rd, Bronx, 10461

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)

Follow Us On Instagram