Patient & Provider Forms

Secure Online Forms for a Seamless Start to Your Care

Access Required Forms Before Your Visit

At California Infusion Centers, we strive to make your care experience as smooth and stress-free as possible. To save time at your appointment, you can complete all required forms online through our secure, HIPAA-compliant platform. Whether you’re a new patient or a referring provider, the forms below will help us prepare for your visit and ensure your treatment begins without delay.

Patient Intake Form

Provide your health history, emergency contact, and insurance details. This information allows our clinical team to create a personalized treatment plan.

Patient Consent Form

This form outlines your rights and authorizes infusion therapy, medical care, data sharing, and insurance billing.

Provider Order Form

For Referring Physicians
Physicians may use this form to submit clinical documentation, medication orders, and treatment details for referred patients.

Assistance Available

Need Help with the Forms?

If you have questions or need assistance with any of the forms, please reach out.

Give Us A Call

(626) 538-4270

Email Us

Info@cainfusioncenters.com