PerformSpecialty, A Full-Service Specialty Pharmacy PerformSpecialty, A Full-Service Specialty Pharmacy
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  • Home
  • Resources
    • Aviso de no discriminación
    • Français
    • Member portal
    • Providers NaviNet Portal
  1. Home
  2. Prescribers
  3. Referral Forms

Referral Forms

Click the name of the form to download a PDF:

  • MS Form (PDF)
  • RA Form (PDF)
  • Generic Referral Form (PDF)
  • Gastroenterology (PDF)
  • Hepatitis C Referral Form (PDF)
  • Osteoporosis Referral Form (PDF)

Accreditations

URAC Accredited Specialty Pharmacy Accreditation
URAC Certified Rare Disease Pharmacy Center of Excellence
ACHC Accredited
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2416 Lake Orange Drive, Suite 190, Orlando, FL 32837 | Email PerformSpecialty | Email PerformRX

855-287-7888 | Monday through Friday | 8:00 a.m. to 7:00 p.m. (ET) | Saturday: 8:00 a.m. to 12:00 p.m. (ET)

 

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Nondiscrimination Statement (PDF)

PerformSpecialty complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Spanish:
PerformSpecialty cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

Chinese Mandarin:
PerformSpecialty 遵守适用的联邦民权法律，不会因种族、肤色、来源国、年龄残疾或性别等原因歧视任何人 (PDF)

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