Choose Nufactor

Alabama Patient Referral Forms

Refer a patient today and our admissions staff will ensure your patient has all the forms and information needed to onboard with Nufactor. Our process is easy and seamless. Download and submit your completed form by faxing it to (855) 270-7347.



HyQvia® Form

Infliximab (Inflectra®, Remicade®, Renflexis®) / Golimumab (Simponi Aria®) Form

Eculizumab (Soliris®) Form

Bleeding Disorder Form

Plasminogen (Ryplazim®) Form

Stelara® (ustekinumab) Form

Tetrabenazine Form

YCANTH™ (cantharidin) Topical Solution 0.7% Form

Other Forms


Talk with us today about referring a patient. Call us at (800) 323-6832 or send an email to and we will be more than happy to help you through the process.