Lux Infusion Referral Forms

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

Actemra Infusion Referral Form

Download

Alpha1-Proteinase Inhibitor Form

Download

B-12 Referral Form

Download

Benlysta Infusion Referral Form

Download

Boniva Referral Form

Download

Briumvi Referral Form

Download

Cimzia Infusion Referral Form

Download

Cinqair Infusion Referral Form

Download

Discontinue Medication Form

Download

Entyvio Infusion Referral Form

Download

Evenity Infusion Referral Form

Download

Fasenra Injection Referral Form

Download

Hydration Infusion Referral Form

Download

Ilumya Infusion Referral Form

Download

Infliximab Infusion Referral Form

Download

Iron Infusion Referral Form

Download

IV Port Flush Referral Form

Download

IVIG Infusion Referral Form

Download

Krystexxa Infusion Referral Form

Download

Leqvio Infusion Referral Form

Download

Leqembi Order Form

Download

Nucala Infusion Referral Form

Download

Ocrevus Infusion Referral Form

Download

Order Form

Download

Orencia Infusion Referral Form

Download

Prolia Injection Referral Form

Download

Reclast Infusion Referral Form

Download

Rituxan Infusion Referral Form

Download

Simponi Infusion Referral Form

Download

Soliris Infusion Referral Form

Download

Stelara Infusion Referral Form

Download

Tepezza Infusion Referral Form

Download

Tezspire Injection Referral Form

Download

Tysabri Infusion Referral Form

Download

Vyepti Referral Form

Download

Vyvgart Referral Form

Download

Vyvgart Hytrulo Referral Form

Download

Xolair Injection Referral Form

Download

Zinplava Infusion Referral Form