Refer to
Reliant
Reliant Specialty Infusion · Reliant Healthcare
We are a pharmacy-rooted provider spanning home infusion and a network of clinically supervised ambulatory infusion centers, offering comfortable, tailored care, plus full benefits and prior authorization support for clinics.
Contact Us
- info@rsinfusion.com
- 888-339-0906
- 833-808-0833
Where We Care
Southern US
Referral Forms
Select the referral form for the drug you're prescribing.
Allergy / Immunology / Pulmonology
- Cinqair
- Exdensur
- Fasenra
- Nucala
- Tezspire
- Xolair
Cardiology
- Amvuttra
- Droxidopa
- Evkeeza
- Leqvio
- Onpattro
Dermatology
- Cimzia
- Infliximab
- Ilumya
- Simponi
- Spevigo
- Tremfya
Endocrinology
- Boniva
- Evenity
- Tepezza
- Thyrogen
Gastroenterology
- Cimzia
- Entyvio
- Infliximab
- Monoferric
- Omvoh
- Skyrizi
- Stelara
- Tremfya
Hepatitis C
- Hepatitis C referral form
HIV
- HIV referral form
Infectious Disease
- Cabenuva
- Dalvance
- Orbactiv
IVIG
- IVIG Dermatology
- IVIG Immunology
- IVIG Neurology
- IVIG Rheumatology
Nephrology
- Krystexxa
- Rituximab
- Soliris
Neurology / Multiple Sclerosis (MS)
- Betaseron
- Briumvi
- Dalfampridine
- Dimethyl Fumarate
- Glatiramer Acetate Injection
- Imaavy
- Kesimpta
- Kisunla
- Lemtrada
- Leqembi
- Ocrevus
- Ocrevus Zunovo
- Rebif
- Rystiggo
- Soliris
- Teriflunomide
- Tysabri
- Ultomiris
- Uplizna
- Vyepti
- Vyvgart
- Vyvgart Hytrulo
Ophthalmology
- Tepezza
Osteoporosis
- Boniva
- Evenity
Podiatry
- Krystexxa
Rheumatology
- Actemra
- Benlysta
- Cosentyx
- Krystexxa
- Infliximab
- Orencia
- Rituximab
- Saphnelo
- Stelara
- Simponi Aria
- Tepezza
Not Sure Which Form You Need?
Call or email us with the therapy and diagnosis, and we'll send the correct form directly to your office.