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

Entyvio Infusion Referral Form

Evenity Infusion Referral Form

Fasenra Injection 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 Injection Referral Form

Reclast Infusion Referral Form

Rituxan Infusion Referral Form

Simponi Infusion Referral Form

Soliris Infusion Referral Form

Stelara Infusion Referral Form

Tepezza Infusion Referral Form

Tezspire Injection Referral Form

Tysabri Infusion Referral Form

Vyepti Referral Form

Vyvgart Referral Form

Vyvgart Hytrulo Referral Form

Xolair Infusion Referral Form

Zinplava Infusion Referral Form