top of page
fluid_art_hand_painted_background_with_glitter_elements_2503.jpg

Submit a Referral

Email: 
orders@premierinfusioncenter.com

Fax: 405.442.7223

1. Download our convenient fillable PDF referral forms for a specific condition or medication below

2. Fax or email to our office along with the necessary patient documentation

That's it!

Premier will take care of verifying the patient’s insurance coverage and working through the prior authorization process if needed.

Healthcare providers can use the forms located on this link or you  can fax your order form to us at orders@premierinfusioncenter.com

fluid_art_hand_painted_background_with_glitter_elements_2503.jpg

Don't see your medication form? Contact us at:

bottom of page