Patient Enrollment and Referral Forms

Fast, convenient intake process


Licensed prescribers can initiate the prescription and care process today.

ARJ is dedicated to coordinating treatment and care for patients with rare and chronic conditions. If your patient requires specialty pharmacy or in-home infusion therapy, we’ll work directly with your team to deliver the highest level of care—no matter where they live.

Our dedicated intake specialists are available to answer questions and coordinate care.

Call: 866-451-8804
Fax: 877-451-8955


Referral Forms by Type:

Specialty Infusion Therapy

General Infusion Therapy Referrals


Intravenous Immune Globulin – IVIg

Pediatric IVIg Referrals

Adult IVIg Referrals


Subcutaneous Immune Globulin – SCIg

Pediatric SCIg Referrals

Adult SCIg Referrals


Entyvio Referrals

Entyvio Standing Orders



Ocrevus Referrals

Ocrevus Standing Orders



Remicade Referrals



Tysabri Standing Orders