Enrollment Forms

Submit the form directly to First Choice staff

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).

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)

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.