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Fax Sheets

Download the fax sheet you need below. If you're a patient, ask your doctor to complete the sheet and fax it to us at (859) 306-0169.

Quick Access to Fax Sheets

Click to download fax sheets. Can’t find the one you need? Contact us, we’re happy to help!

Briumvil

- [Download Fax Sheet]

Omvoh

- [Download Fax Sheet]

Contact Us

Phone: (859) 306-0168         

Fax: (859) 306-0169

Email: info@clarkinfusion.com

For immediate assistance: (317) 504-4295

Note: If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately.

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DISCLAIMER*: Prescription medications require a consultation with one of our licensed healthcare providers. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Please note that individual results may vary, and it is important to follow the guidance of our healthcare professionals for safe and effective treatment. Terms and conditions may apply.

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