Download one of Remedy’s fillable PDF referral forms below. The forms are for a specific condition or a specific medication. Then fax or email to our office with the necessary patient documentation. Don’t worry. The fax and email are Hippa compliant. We will verify insurance coverage and the prior authorizations.
Referral Forms / Infusion Protocols / Patient Assistance
Submit a Referral
Email : MaryLou@okipm.com
Fax: (405) 960 - 4407
Secure Upload
Infusion Forms
Actemra
Adakveo
Aduhelm
Apretude
Avsola
Benlysta
Bivigam
Briumvi
Cabenuva
Cimzia
Cosentyx
Elfabrio
Entyvio
Evenity
Fasenra
Feraheme
Gammagard Liquid
Gammagard S/D
Gamunex-C
Glassia
Ilaris
Ilumya
INFeD
Infliximab
Injectafer (for HeartFailure
Injectafer
Krystexxa
Leqembi
Leqvio
Monoferric
Nucala
Nulojix
Ocrevus
Octagam
Omvoh
Onpattro
Orencia
Panzyga
Privigen
Prolastin
Remicade
Renflexis
Riabni
Rituxan
Rituximab
Ruxience
Rystiggo
Saphnelo
Simponi-ARIA
Skyrizi
Soliris
Stelara
Tepezza
Tezspire
Truxima
Tysabri
Ultomiris
Uplizna
Venofer
Vyepti
Vyvgart
Hytrulo
Vyvgart
Xolair
General Infusion Forms
ALPHA-1 Antitrypsin
Asthma
Erythropoiesis Stimulating Agents
General (Blank)
GI
Iron Deficiency Anemia
IVIG
Migraine Cocktail
SCIG
Here to Help Each and Every Patient
For Providers
Discover the benefits for providers working with REMEDY.
Why Remedy?
At Remedy Infusion Centers, our mission is to provide affordable care for all patients, especially those who are most vulnerable. We believe that access to high-quality infusion therapy should not be limited by financial constraints. By offering cost-effective solutions and working closely with insurance providers, we strive to ensure that every patient receives the care they need without facing excessive financial burdens. Our commitment to affordability is rooted in our dedication to improving the health and well-being of our patients, allowing them to focus on their recovery and overall quality of life.
Comfortable Infusion Suites
Our private and semi-private infusion suites offer a comfortable and relaxing environment for our patients. Equipped with amenities such as a snack bar, Wifi, and plush recliners, our suites cater to individual preferences for a pleasant infusion experience. Whether you prefer a more private setting or enjoy the company of others in a semi-private suite, we strive to provide a soothing atmosphere to make your infusion process as comfortable as possible.
Get started with Remedy, today.
Request a visit from one our our Remedy representatives today to learn more. We can come to your office to discuss our therapies.