Referral Forms by Therapeutic Areas

We have our referral forms listed by Therapeutic Expertise categories. If you cannot find the specific form you need, we encourage you to reach out to our dedicated support team. We are committed to providing personalized assistance and finding solutions that meet your unique healthcare needs.

Rare Diseases

Atypical hemolytic uremic syndrome (aHUS) Referral Form

Crysvita® Referral Form

GIVLAARI® Referral Form

IgG4-RD Referral Form

ONPATTRO® Referral Form

OXLUMO® Referral Form

Paroxysmal Nocturnal Hemoglobinuria Referral Form

RYPLAZIM® Referral Form

UPLIZNA® Referral Form

TEPEZZA® Referral Form

VILTEPSO® Referral Form

Allergy and Asthma

Asthma Referral Form

Bleeding Disorders

Bleeding Disorders Referral Form

RYPLAZIM® Referral Form

QFITLIA™(fitusiran) Referral Form

Cardiovascular

AMVUTTRA® Referral Form

Chronic Inflammatory Disorders

Chronic Gout Referral Form

Dermatology Referral Form

Infectious & Autoimmune Encephalitis (IAE) Referral Form

Gastroenterology and Rheumatology

Gastroenterology Referral Form

Hydration and Nutrition Referral Form

KRYSTEXXA® Referral Form

Rheumatology Referral Form

General

Acute Home Infusion Referral Form

General Infusion Referral Form

Immunoglobulin Therapy

Immunoglobulin Referral Form

YIMMUGO® REFERRAL FORM

Neurological Disorders

Alzheimer’s Disease Referral Form

AMVUTTRA® Referral Form

Amyotrophic Lateral Sclerosis (ALS)

IMAAVY™ Referral Form

Multiple Sclerosis Referral Form

Myasthenia Gravis Referral Form

ULTOMIRIS® & SOLIRIS® Referral Form

ULTOMIRIS® & SOLIRIS® Referral Form – Spanish

VYVGART™ and VYVGART Hytrulo® Referral Form

VYEPTI® Referral Form

Ophthalmology

Neuromyelitis Optica Spectrum Disorder (NMOSD) Referral Form

Ophthalmology Referral Form

TEPEZZA® Referral Form

Submitting Your Referral

Fax

Fax your completed referral form to 844.797.5050

Email

Scan and email your completed referral form to our secure email at SpecialtyReferrals@SoleoHealth.com

Phone Support

Call us at 844.575.1515 for any questions or assistance

Referral Process Expectations

Our referral process is designed with both healthcare providers and patients in mind.

  • Quick and accurate processing
  • Comprehensive clinical documentation management
  • Personalized patient care coordination
  • Seamless communication between healthcare providers

Our team is dedicated to supporting you throughout the referral process and ensuring that your patients receive the highest-quality specialized healthcare services.

FAQs

Do you provide timely reports on my patients referred to you?

Soleo Connect provides real-time access to patient information, reports and updates.

How do I stay informed on essential patient updates?

Soleo Connect is our secure patient and provider communication and care management system. It is accessible through a web portal or mobile app.

Soleo Connect seamlessly accesses Soleo Health’s pharmacy and nursing system, allowing for real-time access to patient information, including demographic information, medications, prescriptions, labs, nursing progress notes, equipment dispensed, referrals and documents shared by Soleo Health.

Patients and their caregivers also stay connected to the information needed to manage their care easily and efficiently.

Do you participate in all of the major health insurance plans?

Soleo Health participates in all major national, regional and local health insurance plans, PBMs, Medicare and Medicaid. Contact your local branch or call us at 844.575.1515 or specialtyreferrals@soleohealth.com to find out if we are in network with your patient’s health insurance.