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PMD Healthcare PMD Healthcare

Spiro PD 2.0 Referral Form

How to get your Spiro PD 2.0

Here’s what you need to do:

For Healthcare Professionals:

  1. Download and complete the appropriate referral form
  2. Submit the signed referral form to Optimed Specialty Pharmacy

For Patients:

  1. Download and complete the appropriate referral form
  2. Have your healthcare professional sign the referral form
  3. Submit the referral form to Optimed Specialty Pharmacy
Select the best referral form below:
Spiro PD 2.0 prescription form for Patients Post Lung Transplant
Spiro PD 2.0 prescription form for Patients with Cystic Fibrosis
Spiro PD 2.0 prescription form for Patients with Pulmonary Fibrosis
Spiro PD 2.0 prescription form for Patients Any Other Condition

Fax the completed form directly to OptiMed Specialty Pharmacy Services at 877-326-2856
and we’ll do the rest!