For all patient referrals, please complete the online pre-determination form. In separate files please submit the supporting clinical documentation required.
Download blank Sirtex Patient Consent Form.
Should you have any questions, please contact the reimbursement team by phone at 888-4-SIRTEX (474-7839) ext. 717 or email email@example.com. If you are unable to upload the clinical or consent files, please send them via fax to 877-642-7888.
SIR-Spheres® is a registered trademark of Sirtex SIR-Spheres Pty Ltd.
Online pre-determination form
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