Referral forms

Send your referral electronically using our prescriber website MyAccredoPatients.com. Simply register or login and navigate to "Send a Referral" on the dashboard. Once logged in, you will be routed to iAssist, which is Accredo’s electronic referral service. If you are not registered for iAssist, you will be prompted to do so.

Alternatively, if you are unable to send an electronic referral, you can find the referral form by specialty condition and product name in the list below. Then, fill in the required prescription and enrollment information and fax it to us at the number printed on the form. Referral form submissions must be sent from licensed prescribers. We are committed to providing the best care for your patients.

Search by the first letter of the specialty condition that interests you.

A

B

C

D

E

G

H

I

M

N

O

P

R

S

T

U