Lux Infusion Referral Forms

We have made referrals for medical infusion treatments easy and convenient for our referring providers.

Please use any of these forms to quickly fill and fax your patient’s orders and insurance information — and LUX Infusion will take it from there!

Send us a referral via fax or email

Fax: (907) 921-7669

Email: contact@luxinfusion.com

Downloadable Order Forms

Actemera Infusion Referral Form

Alpha1-Proteinase Inhibitor Form

B-12 Referral Form

Benlysta Infusion Referral Form

Boniva Referral Form

Briumvi Referral Form

Cimzia Infusion Referral
Form

Cinqair Infusion Referral Form

Dupixent Referral Form

Entyvio Infusion Referral Form

Evenity Infusion Referral Form

Fasenra Infusion Referral Form

Hydration Infusion Referral Form

Ilumya Infusion Referral
Form

Infliximab Infusion Referral Form

Iron Infusion Referral Form

IV Port Flush Referral Form

IVIG Infusion Referral
Form

Krystexxa Infusion Referral Form

Leqembi Order Form

Leqvio Infusion Referral
Form

Nucala Infusion Referral Form

Ocrevus Infusion Referral Form

Order Form

Orencia Infusion Referral Form

Prolia Infusion Referral Form

Reclast Infusion Referral Form

Rituxan Infusion Referral Form

Simponi Infusion Referral Form

Soliris Infusion Referral
Form

Tepezza Infusion Referral Form

Tezspire Injection Referral Form

Tysabri Infusion Referral Form

Vyepti Referral Form

Xolair Infusion Referral Form

Zinplava Infusion Referral Form