Submit a Referral

Three ways to send us a patient referral

1 · ONLINE

Fill out an e-referral form

Fastest for most offices. Pick the medication and fill out its online form.

Find a medication →
3 · FAX

Traditional Fax

Print the PDF and fax it with everything listed in the medication's requirements.

(410) 630-3882

Upload a completed referral

Include the referral form plus everything in the medication's requirements: labs, insurance cards, office notes, etc.

HIPAA-secure upload through Formstack
Please don't email referrals.
Email isn't secure for patient information. Upload it here or fax it to (410) 630-3882.

Questions about a referral? Call (410) 357-1125