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Find the forms related to a specific condition using the below list of our most common medications. If you do not see your particular form or medication listed, use our General Specialty Form, General Injectable Form, or General Infusion Form.

Specialty Services & Forms.

OptiMed is committed to taking a different approach by creating customized solutions that enhance quality, minimize costs, and maximize patient outcomes.

We communicate regularly with patients and providers to keep the whole care team informed of the patient’s treatment progress.

If you are unable to locate the appropriate referral form, please use our General Specialty Form.

Infusion Services & Forms.

We keep patient outcomes at the heart of everything we do to build a unified, value-based partnership with you, your patients, and your insurance companies. We communicate regularly with you, the provider, about your patients and always keep you informed of their health progress.

Please use our General Injectable Form or General Infusion Form if you cannot locate the appropriate referral form.

SPRAVATO® Referral Form

Download the form by visiting the SPRAVATO® Services page. You can also attach the form and send it in via the website!

OptiMed provides complimentary shipping and handling of all medications and supplies. Expedited shipping may result in a small fee. Remote or Home infusion may be an option for some patients. The site of care will be determined based on the patient’s medical provider(s), medical status, safety considerations of the medication, drug labeling, and payer specifications.

Call OptiMed at (877) 232-2857 to see if you’re eligible for Remote Infusion Therapy.

Page last updated on 06/07/2023.