At Kings Pharmacy, we understand the importance of quality patient care. These referral forms make sending specialty prescriptions to Kings Pharmacy an easy and fast process!

Simply download the appropriate form, type or print the requested information, and fax it to Kings Pharmacy with any relevant clinical information. We also have a list of documentation we request from physicians for referral of certain conditions (please see below).

Please note than an original prescription must accompany each referral. We encourage you to e-scribe to make the process even easier!

Once we receive a completed referral form, our dedicated team at Kings Pharmacy will verify insurance coverage, provide prior authorization support, coordinate financial assistance and delivery of medication(s), and monitor the patient throughout treatment to ensure adherence and successful completion.

This section is for prescribing practitioners ONLY and not intended for patient use. Faxed referrals and accompanying prescriptions will only be accepted from prescribing practitioners.

 

Gastroenterology Referral Form


 

Hepatitis C Referral Form

Requested Documentation for Hepatitis C Referrals


 

IVIG Referral Form

Requested Documentation for IVIG Referrals


 

Rheumatology Referral Form


 

derm   Dermatology Referral Form


 

botox   Botox Referral Form for Chronic Migraines

                Botox Referral Form for Hyperhidrosis


 

Please contact Kings Pharmacy if a referral form is not available for the desired medication and/or disease state.