Referral Forms

Please select and download the appropriate Form. Once filled out, you can choose any method to submit. You may also find us on SureScripts eprescribing network. 

 Please contact us if you are interested in medications for treatment of a disease process not found here.


Fax:       225-243-7957

mail:      34972 Old La Hwy 16, Ste. A

                Denham Springs, La. 70706

HaloCare Specialty Therapeutics appreciates your referrals.