Referring Patients is Easy

Online: Complete our electronic referral form and upload documents directly.

Fax or Email: Download, print, and send the completed form with supporting documents.


We’ll handle the rest, including benefits verification and prior authorizations.

Phone: (727) 877-7015 | Fax: (727) -683-9647 Email: infusion@evarahealth.org

Treatment Referral Forms

Actemra®

PDF
Online

Cimzia®

PDF
Online

General Form

PDF
Online

Injectafer®

PDF
Online

Leqembi®

PDF
Online

Orencia®

PDF
Online

Renflexis®

PDF
Online

Simponi®

PDF
Online

Spevigo®

PDF
Online

Venofer®

PDF
Online

Xolair®

PDF
Online

Amvuttra®

PDF
Online

Cinqair®

PDF
Online

Entyvio®

PDF
Online

Glassia®

PDF
Online

IVIG®

PDF
Online

Lumizyme®

PDF
Online

Prolastin®

PDF
Online

Riabni®

PDF
Online

Stelara®

PDF
Online

Tzield®

PDF
Online

Tysabri®

PDF
Online

Avsola®

PDF
Online

Cosentyx®

PDF
Online

Evenity®

PDF
Online

Hydration

PDF
Online

Infed®

PDF
Online

Ilaris®

PDF
Online

Nucala®

PDF
Online

Prolia®

PDF
Online

Rituxan®

PDF
Online

Saphnelo®

PDF
Online

Tepezza®

PDF
Online

Vyepti®

PDF
Online

Benlysta®

PDF
Online

Crysvita®

PDF
Online

Feraheme®

PDF
Online

Inflectra®

PDF
Online

Ilumya®

PDF
Online

Nulojix®

PDF
Online

Reclast®

PDF
Online

Ruxience®

PDF
Online

Skyrizi®

PDF
Online

Tremfya®

PDF
Online

Tezspire®

PDF
Online

Vyvgart®

PDF
Online

Briumvi®

PDF
Online

Dupixent®

PDF
Online

Fasenra®

PDF
Online

Infliximab®

PDF
Online

Leqvio®

PDF
Online

Krystexxa®

PDF
Online

Ocrevus®

PDF
Online

Remicade®

PDF
Online

Rystiggo®

PDF
Online

Soliris®

PDF
Online

Ultomiris®

PDF
Online

Vyvgart Hytrulo®

PDF
Online
Policy and Procedure Library