Order Form

TECENTRIQ® (atezolizumab)

TECENTRIQ® is a cancer immunotherapy indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma. TECENTRIQ® is administered by intravenous infusion that can help reactivate the immune system so it can recognize cancer cells in the body.

For more information, please refer to the TECENTRIQ website, prescribing information, and/or medication guide.

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?

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.

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.