patient education center

Patient Forms & Pre-Registration

Submit your patient information before your visit so our team can begin verifying benefits, processing authorizations, and preparing for your infusion or injection appointment.

IV infusion bag and tubing in a bright clinical treatment room
Patient Forms & Pre-Registration

Why Pre-Registration Matters

Before we can begin insurance verification, prior authorization, medication procurement, or scheduling, we must collect patient demographic and insurance information. Patients may complete their admission packet two ways.

  • through our secure HIPAA-compliant online registration portal
  • by downloading and completing a paper packet.

Our preferred form of submission is through our online registration system integrates directly with our clinical infusion management platform, allowing our team to begin processing benefits and authorizations as quickly as possible.

Prompt completion of your admission packet allows our team to begin processing benefits and authorizations as quickly as possible.

IV drip chamber and tubing in a clinical infusion setting
QR code to complete online patient registration
option 1

Complete Online Registration

Our online registration portal is HIPAA-compliant and securely integrated with our clinical infusion management platform. Information submitted through the portal is securely transmitted to Citrus Infusion & Injection Center and allows our team to begin insurance verification and authorization processing as quickly as possible.

Benefits include:

  • HIPAA-compliant & secure
  • Faster insurance verification
  • Faster prior authorization processing
  • Less paperwork on appointment day
  • Reduced scheduling delays
option 2

Download & Print Forms

Prefer paper forms? You may download the Patient Admission Packet, complete it by hand, and return it to our office by email, fax, mail, or in person. Please complete all forms and include the following documents with your packet:

  • Driver's license or photo identification
  • Front and back of your insurance card(s)
  • Current medication list
  • Referring provider information
  • Emergency contact information

Completed forms may be returned by:

**Please do not forget to include a copy of the back and front of both your insurance cards and identification.

Healthcare professional holding an IV bag with fresh fruit in a clinical setting
IV drip chamber and tubing in a clinical infusion setting
patient forms &pre-registration

Before We Can Begin Your Benefits Investigation

To begin insurance verification and authorization processing, Citrus Infusion & Injection Center must receive both your healthcare provider’s referral and treatment orders, as well as your completed Patient Admission Packet.

Once both items are received, our team can begin reviewing benefits, authorization requirements, estimated out-of-pocket costs, medication coordination, scheduling, and communication with your referring provider. Because many infusion and injection therapies require insurance authorization before treatment can begin, completing your admission packet as soon as possible helps avoid delays.

patient forms & pre-registration

What Happens Next?

Once we receive your provider's referral and your completed admission packet, our team begins the benefits investigation process and coordinates next steps with your referring healthcare provider. This may include verifying active insurance coverage, reviewing medical benefit eligibility, checking deductible status, reviewing coinsurance and copay requirements, determining prior authorization requirements, reviewing possible manufacturer assistance opportunities, and preparing for scheduling once requirements are complete.

Whenever possible, our team provides an estimated out-of-pocket cost summary before treatment begins. This may include medication costs, administration costs, deductible obligations, coinsurance responsibilities, manufacturer copay assistance, and estimated patient responsibility. Throughout the process, Citrus Infusion & Injection Center communicates with your referring healthcare provider to support continuity of care.

Updates may include referral receipt confirmation, insurance verification status, prior authorization updates, scheduling status, treatment completion notifications, and any clinical concerns requiring provider review. After each infusion or injection appointment, treatment documentation is sent directly to your referring provider so they remain informed and can continue directing your treatment plan.

Patient receiving IV infusion therapy in a comfortable clinical treatment chair