Submit Referral
Submit Referral


A simple and transparent referral process

Refer a patient to Local Infusion in less than 5 minutes


Send us the referral order


Complete and send us:

Signed order form

Supporting clinicals



And we handle the rest

Our team will take care of:

Prior authorization

Financial assistance & counseling

Scheduling the patient appointment

Provide an incredible patient experience

Post treatment follow up

And keep you updated along the way


Get the referral process started today

Submit & eSign Digitally

*We'll send a confirmation email and you can download a copy for your records.

You can download therapy-specific order forms here
Already submitted an order form and looking to submit additional instructions or clinical documentation? Access our secure document upload here.

Local Infusion accepts coverage from the following health insurances

We're committed to financial transparency. No surprise bills or hidden costs, and financial assistance support for every eligible patient. Cost should never be a barrier to your care. 

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