Enrollment Forms

Download and submit the form directly to First Choice staff

Please note that to Submit the Form directly to the staff, before entering any information, you will first need to download the form to your computer and open in Adobe Acrobat Reader (if you do not have Adobe Acrobat Reader installed, you can download for free here) in order to use this functionality. Once you have completed the form, clicking Submit the Form button will create a new email and automatically attach the completed form to send through your preferred email system. You can also attach any additional required documents before sending.

Submissions to our Specialty Pharmacy may be completed using your own forms or prescriptions, please free to use those and email (referrals@firstchoiceiv.com) or fax (1-844-324-3244). These are simply aides available for your use.

Wellness & Infusion Center enrollments are recommended to use our Infusion Services forms focused on specific medications as we are always adding to our growing list of treatment options. First Choice is proud to offer enrollment forms for new infusion treatments as they are approved and strive to make this process as quick and issue free as possible. We continue to also accept any non-First Choice forms as well and all enrollments can be sent via email (infusions@firstchoiceiv.com) or fax (1-844-461-3244)

If you are unable to use Adobe Acrobat Reader for any reason, all of these forms can also be printed to be used as fax or email attachments as well.

We offer our forms focused on the areas of Specialty Pharmacy and Infusion Services in order to best assist in patient care options. If you have any questions or feedback on these forms, please contact us and we will be glad to help in any way we can.