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Patient Referral

Complete the form below to initiate a referral or infusion consultation. Our team will review and follow up promptly.

Referral Details

Please complete the form below

Select Service Needed

Referral Documentation

Please Upload signed physician order, referral form, or prescription. PDF preferred.

Labs, insurance, notes

Please do not use this form for emergency medical needs. Submitted information is handled securely and in accordance with applicable privacy standards. For highly sensitive or urgent matters, please contact our team directly. We will follow up via your preferred method.

Call or Email Our Team

(716) 352-6960

Phone

Mon — Fri: 8:00 AM — 4:30 PM. Typical response within 4 clinical hours.

Referrals

referrals@aurainfusions.com

HIPAA-compliant portal for provider orders and clinical documentation.

General Info

info@aurainfusions.com

For general inquiries, billing questions, and scheduling assistance.

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