Call our number at (310) 828-3690 to speak with a Infusion Connection Intake Coordinator.

Referral forms may be downloaded, completed, and faxed to Infusion Connection at (310) 828-3697.

Please note: Faxed prescriptions can only be accepted directly from the prescribing practitioner. If you are self-referring using the Fax Referral Form, a physician’s signature and an original prescription drug order are required.

If the submitted materials contain Protected Health Information (PHI), Infusion Connection will strictly adhere to HIPAA Privacy regulations to ensure confidentiality and compliance.