Referral Forms are an integral part of a specialty pharmacy’s referral process.  A referral form is the method in which a referral source will send over a patient to your specialty or compounding pharmacy.

At UpTrend, our Referral Form Programs allow you to be efficient and effective when handling every referral that comes through your pharmacy. Custom referral forms are designed with the disease states your service in mind.  Forms are branded with your logo and contact information, and designed with a clean, easy to use format making it simple for your referral sources and your staff to read and fill out.

Our Referral Form Program also includes updates to all forms as needed and prompt edits for new medications, dosages & discontinued products. Referral Forms come in both printable and fillable PDF formats, which give your referral sources the flexibility to fill them out online, or on paper.

Here are some of the forms that we offer – don’t see one you need? Just ask!

SPECIALTY REFERRAL FORMS

Anemia
Antipsychotic
Crohn’s & Ulcerative Colitis
Dermatology
Endocrinology
General
Hepatitis C
HIV/AIDS
Low Molecular Weight
Multiple Sclerosis
Oncology
Rheumatoid Arthritis

COMPOUNDING REFERRAL FORMS

Dermatology
General
Hormone Therapy
Pain Management Therapy
Veterinary

Specialty Referral Forms