FAX REFERRAL FORM

Patients with Humana HMO, TRICARE Prime Remote, or UHC Compass need a prior authorization

Please include patient labs and past clinic notes as appropriate with your referral. Iowa Allergy will fax a patient’s appointment back to your clinic once we schedule them. We will fax notes after patient’s visit. We sincerely appreciate your referral and please do not hesitate to call with any questions.