Biologic Referral Forms

Send a referral via fax at 866-507-1164 or email to MICreferral@MetroInfusionCenter.com

A direct line to reach the biologic nurse team is (877) 448-3627. If you receive a voicemail, please leave a message with your callback information. A nurse answers all calls the same day.

We offer services to patients with a wide range of chronic conditions.

MISCELLANEOUS REFERRAL FORM

ACTEMRA (TOCILIZUMAB)

AVSOLA (INFLIXIMAB-axxq)

BENLYSTA (BELIMUMAB)

Briumvi (Ublituximab-xiiy)

CEREZYME (IMIGLUCERASE)

CIMZIA (CERTOLIZUMAB)

CINQAIR (RESLIZUMAB)

CRYSTVITA (Burosumab-twza)

ENTYVIO (VEDOLIZUMAB)

EVENITY (ROMOSOZUMAB-aqqg)

EVKEEZATM (evinacumab-dgnb)

FASENRA (BENRALIZUMAB)

ILUMYA (TILDRAKIZUMAB)

INFLECTRA (INFLIXIMAB-dyyb)

Infliximab/Biosimilar

INJECTAFER (FERRIC CARBOXYMALTOSE)

INTRAVENOUS IMMUNOGLOBULIN

KRYSTEXXA (PEGLOTICASE)

LEQEMBI (LECANEMAB-IRMB)

LEMTRADA (ALEMTUZUMAB)

OCREVUS (OCRELIZUMAB)

OMVOH IV (MIRIKIZUMAB-MRKZ)

RECLAST (ZOLEDRONIC ACID)

REMICADE (INFLIXIMAB)

RENFLEXIS (INFLIXIMAB-abda)

Rituximab (Rituxan)

Skyrizi IV (Risankizumab-rzaa)

SIMPONI ARIA (GOLIMUMAB)

SOLIRIS (ECULIZUMAB)

Spevigo (Spesolimab-sbzo)

STELARA (USTEKINUMAB)

TEPEZZA (TEPROTUMUMAB-TRBW)

TEZSPIRE (Tezepelumab)

TYSABRI (NATALIZUMAB)

Ultomiris (Ravulizumab-cwvz)

Uplizna (inebilizumab-cdon)

Vyepti (Eptinezumab-jjmr)

VYVGAR (Efgartigimod alfa-fcab)

XOLAIR (OMALIZUMAB)

ZINPLAVA (BEZLOTOXUMAB)

Oncology Referral Forms

If you need help or have questions please email: bionurses@metroinfusioncenter.com

chemo policy metro infusion

ado trastuzumab REFERRAL FORM

Atezolizumab REFERRAL FORM

Bevacizumab REFERRAL FORM

Bortezomib order REFERRAL FORM

brentuximab Vedotin REFERRAL FORM

cemipilumab REFERRAL FORM

Dara faspro REFERRAL FORM

denosumab REFERRAL FORM

Durvalumab REFERRAL FORM

Faslodex REFERRAL FORM

Firmagon REFERRAL FORM

Goserelin REFERRAL FORM

ipilumumab REFERRAL FORM

Jemperli REFERRAL FORM

Lanreotide REFERRAL FORM

Leuprolide Acetate (Eligard) SQ

Lupron Depot, Lupron Depot-PED (leuprolide)

Nivolumab REFERRAL FORM

Octreotide REFERRAL FORM

Pegfilgrastim REFERRAL FORM

Pembrolizumab REFERRAL FORM

Pemetrexed REFERRAL FORM

pertuzumab REFERRAL FORM

pertuzumab/trastuzumab/hyaluronidase-zzxf REFERRAL FORM

RBC growth factor REFERRAL FORM

RITUXAN (RITUXIMAB)

Romiplostim REFERRAL FORM

Trastuzumab (Herceptin)

Triptorelin REFERRAL FORM