Click the “Submit a Referral” button to see our form. Click the appropriate treatment and fill out the form – two easy ways to submit once downloaded:

A) Print, complete, and fax

OR

B) Complete by typing into the form fields on the computer and email/fax

Please be sure to attach all clinical notes, labs, and insurance information.

EMAIL: info@premiervitalitymd.com

We work directly with insurance providers to receive treatment pre-authorization.

We will contact the patient to set expectations for the pre-authorization process that typically takes 5-7 business days.

Post pre-authorization approval, we will contact the patient to share infusion information and schedule an appointment.

We will also assist with any available financial assistance programs.

Our expert medical staff administers infusions while pampering the patients in our relaxing, comfortable, spa-like atmosphere.

Our nurses will check on the patient within the first 24 hours of the infusion.

Expect precise, prompt communication with your practice including detailed patient reports following every infusion.