Accessibility Tools

Simple and Easy 3-Step Referral Process2

Simple and Easy 3-Step Referral Process

The referral forms are available on our website, here. These referral forms can be signed by the referring physician and faxed to our pharmacy. A copy will be sent to our business office who will get the patient approved for the treatment and notify the receptionists when the patient is ready to be scheduled.

  • Download Patient Referral Forms

    Download the available infusion referral forms. NTIC offers many different drugs for infusion/injection. Print and complete the appropriate form or contact our office at to request a form. Fax the form to our pharmacy at .

  • Patient Scheduled

    After receiving the completed referral form and medical records, NTIC Specialty Intake Coordinator verifies benefits and the patient is scheduled at either our Downtown Dallas office or the NorthPark / Carrell Clinic office.

  • Scheduled Appt.

    After the patient has been seen in the infusion center, a record of the patient’s visit is faxed to the referring physician. A fax will be sent to the physician if a patient can not be reached to set up an appointment or does not show up for a scheduled appointment.

We Work with All Major Insurance Companies

Our staff of 17 insurance specialists work with all of the major insurance companies as well as the drug manufacturers for co-payments assistance. Along with the referral form we request the most recent labs and clinical notes. After the patient has received their treatment a copy of the infusion visit will be sent to the physician office for review.