InfusionMed USA - Modern Infusion Center

For Providers

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REFER YOUR PATIENT TO US

OPTION 1:

Find your requested infusion treatment below and click “FILL AND SIGN” to complete our HIPAA-compliant order form online. Easily upload patient labs / insurance information and click SUBMIT!

OPTION 2:

Find your requested infusion treatment below and click “DOWNLOAD FORM.” Complete the order form and fax it back to us with patient labs / insurance information.
Fax Number: 972-810-0994

Medical Infusion Therapy Treatments

NEXT STEPS:

After we receive the order form and patient information, we will handle all other details involving the patient’s infusion therapy treatment.

FOLLOW-UP:

We will keep you and your office updated on the patient’s status throughout the insurance approval process and during /after the course of infusion treatment

MEDICAL INFUSION THERAPY

ORDER FORMS

Our therapy-specific order forms are below. Please note that we routinely update our forms to comply with new insurance requirements. To inquire about a specific therapy not listed below, please feel free to contact us or complete a blank order form. We can also email, fax or deliver forms directly to your office!

INFUSION ORDER

FILL AND SIGN
DOWNLOAD FORM

IV HYDRATION ORDER

FILL AND SIGN
DOWNLOAD FORM

IV ANTIBIOTIC ORDER

FILL AND SIGN
DOWNLOAD FORM

IVIG INFUSION ORDER

FILL AND SIGN
DOWNLOAD FORM

IV IRON ORDER

FILL AND SIGN
DOWNLOAD FORM

IV SOLUMEDROL ORDER

FILL AND SIGN
DOWNLOAD FORM

BIOLOGIC FORMS

ACTEMRA

FILL AND SIGN
ORDER FORM

AVSOLA

FILL AND SIGN
ORDER FORM

BENLYSTA

FILL AND SIGN
ORDER FORM

CINQUAIR

FILL AND SIGN
ORDER FORM

ENTYVIO

FILL AND SIGN
ORDER FORM

INFLECTRA

FILL AND SIGN
ORDER FORM

KRYSTEXXA

FILL AND SIGN
ORDER FORM

ONPATTRO

FILL AND SIGN
ORDER FORM

ORBACTIV

FILL AND SIGN
ORDER FORM

ORENCIA

FILL AND SIGN
ORDER FORM

PROLASTIN-C

FILL AND SIGN
ORDER FORM

REMICADE

FILL AND SIGN
ORDER FORM

RENFLEXIS

FILL AND SIGN
ORDER FORM

RITUXAN

FILL AND SIGN
ORDER FORM

SOLIRIS

FILL AND SIGN
ORDER FORM

STELARA

FILL AND SIGN
ORDER FORM

TEPEZZA

FILL AND SIGN
ORDER FORM

TYSABRI

FILL AND SIGN
ORDER FORM

UPLIZNA

FILL AND SIGN
ORDER FORM

VYPETI

FILL AND SIGN
ORDER FORM

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TESTIMONIALS

Raving Reviews from Real Patients

 
 
 
 
 
 
 
  
 
 
 
 Gabriela Castillo 
 
 
 Gabriela Castillo 
 
2023-10-17
 
 
  
Will definitely come back great service
  
 
  
 
 
 
 Isaiah Roberts 
 
 
 Isaiah Roberts 
 
2022-09-14
 
 
  
Very helpful, very patient, very good service and gave me a crazy good deal on my immunity iv therapy. Thank you.
  
 
  
 
 
 
 Typhanie mcroberts 
 
 
 Typhanie mcroberts 
 
2022-07-08
 
 
  
Omg they are so polite here, only my second time they new exactly who I am walked me back etc such positive vibes here.
  
 
  
 
 
 
 Jeremiah Quila 
 
 
 Jeremiah Quila 
 
2022-04-22
 
 
  
This was the best experience I've ever had at a medical facility. Nurse Ina went above and beyond the call of duty. She and the staff their did an excellent job. The office was nice calm and inviting a fantastic office. Very laid back but professional. Would RECOMMEND to anyone needing services in this field or area.
  
 
  
 
 
 
 JR “BASICXSLAYS” 
 
 
 JR “BASICXSLAYS” 
 
2022-04-20
 
 
  
I spent the last few weeks getting antibiotics every morning and the staff made me feel really comfortable and over all friendly. I really want to thank both of the staff that took care of me for these few short weeks. I appreciate y’all!
  
 
  
 
 
 
 Yaneth Rivas 
 
 
 Yaneth Rivas 
 
2022-01-29
 
 
  
Me and my husband went in for immunity boost! Great spa like place and very friendly staff! Will be back for lipo shot and Gorgeous infusion!
  
 
  
 
 
 
 Nga Pham 
 
 
 Nga Pham 
 
2021-11-30
 
 
  
Very good