Contact Us
Refer a Patient

Start a Referral

We deliver a rapid response to referrals and fast coverage verification with 24/7 support for providers and patients from specially trained infusion nurses and pharmacists.

Red Bank Infusion Center updates its formulary on a continual basis. To inquire about a specific therapy not listed below, please contact us.

To begin a new referral, select the therapy below, then download the referral checklist, and the prescriber order PDF form and either fax to (732) 529-2668 or email to referrals@redbankinfusioncenter.com

Download

Download the PDF(s) forms you need from our list when you start.

1.

Fill, Print & Sign

Complete the form(s) online or by hand, print the form(s) and sign.

2.

3.

Send Forms

Fax or email your signed form(s) to Red Bank Infusion Center.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download364 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download265 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals
That’s it! You may now fax or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download265 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals
That’s it! You may now fax or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download248 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download265 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals
That’s it! You may now fax or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download265 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals
That’s it! You may now fax or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

Step 1

Review our Referral Checklist.

Download457 KB

Step 2

Complete the therapy-specific Order Form.

Download440 KB

Step 3

Gather the supporting clinical materials.

Review Clinicals

That’s it! You may now fax the information to (732) 529-2668, or email the information to us at referrals@redbankinfusioncenter.com, and we take care of the rest.

Need help? Call us anytime at (732) 977-7932.

(732) 977 – 7932

130 Maple Avenue

Building 6, Suite 6

Red Bank, NJ 07701

Please include the following information when submitting a referral for IVIG:

(includes Bivigam, Carimune, Flebogamma, Gammaplex, Asceniv, Gamimune, Gammar-P IV, Panzyga, Gamunex-C, Gammaked, Gammagard, Privigen)

  • Patient diagnosed with Primary Immunodeficiency
  • Clinical history and information to support one or more of the following:
    • Patient has Chronic Inflammatory Demyelinating Neuropathy (CIDP)
    • Patient has Myasthenia Gravis
  • Clinical laboratory results including:
    • BUN / Creatinine in the most recent 30 days

Please include the following information when submitting a referral for ACTEMRA:

  • Results of a recent tuberculosis (TB) skin/lab testing
  • Clinical history and information to support one or more of the following:
    • Patient has moderately to severely active rheumatoid arthritis (RA) who has had an inadequate response to one or more disease modifying anti-rheumatic drugs (DMARDs)
    • Patient has giant cell arteritis (GCA)
    • Patient has active polyarticular juvenile idiopathic arthritis (PJIA)
    • Patient has active systemic juvenile idiopathic arthritis (SJIA)
Please include the following information when submitting a referral for Infliximab (Remicade, Inflectra, Renflexis, Avsola):
  • Result of Tuberculosis (TB) skin/ lab testing
  • Patients current weight and height
  • Clinicals to support one or more of the following:
    • Patient has active moderate to severe Crohn’s disease (CD)
    • Patient has active moderately to severely active Ulcerative Colitis (UC)
    • Patient has Rheumatoid Arthritis (RA)
    • Patient has Psoriatic Arthritis
    • Patient has Ankylosing Spondylitis
    • Patient has Plaque Psoriasis

Please include the following information when submitting a referral for VYEPTI:

  • Clinicals to support an indication for the preventive treatment of migraines in adult patients
  • Patient has a history of migraines and has been on 2 oral preventatives and has experienced 4 or more migraines within a month period