Order Form


Gammagard Liquid is used to treat patients with primary immunodeficiency (PI) who are two years of age and older. It is also used to treat adults with multifocal motor neuropathy (MMN). The dosage will vary depending on the type of condition being treated and the age of the patient.

To learn more, please refer to the Gammagard website and full prescribing information.

Note: Please speak with your healthcare provider for more information if you think this therapy might be right for you.

How do I make a referral or transition my treatment to Infusion Associates?

Customized Care

1. Ask your healthcare provider to fax us a completed order form for your medication, clinical notes, demographics and your insurance card to (833) 996-4888.

2. Providers can find order forms on our medications page.

On Staff Pharmacist

3. One of our intake specialists will contact your healthcare provider to confirm receipt of your referral.

4. We will then verify benefits, obtain any required prior authorizations, and contact you to schedule an appointment.