Make A Referral
Make A Referral
1. Download, Fill In, and Sign the Patient Referral Form
Please download the patient referral form below that meets your needs. Once downloaded, please fill in the form with your patient’s information and sign it. Note: This will include their personal information, diagnosis, premedications and infusion dosage, so please prepare accordingly.
2. Fax the Completed Form to (510) 969-5840
Once the patient referral form has been completed and signed, please fax the completed form to (510) 969-5840, along with the following information:
Patient demographics and insurance information
Relevant test results
Relevant clinical/progress notes
Diagnostic studies supporting primary diagnosis
3. Total Infusion Care Team
The Total Infusion Care Team will take care of authorization for treatment, enrolling patients in drug sponsored financial assistance programs, and patient scheduling.
Thank You for the Referral
If you have any questions for us regarding the referral process, please feel free to reach out using the contact information listed below.
ADDRESS:
Eastmont Town Center 6955 Foothill Blvd, Suite 67A, Oakland, CA, 94605
PHONE:
EMAIL:
BUSINESS HOURS:
Monday – Friday:
8:30am-5:00pm