Provider Referral Form

October 18, 2021

Thank you for your interest in monoclonal antibody therapy at Mount Nittany Health. Mount Nittany Health will offer two monoclonal antibody treatments per day, Tuesday through Saturday, with the exception of October 23, November 13 and 20. Patients must be referred for treatment by a provider.

By completing this form, your patient will be included in the first come, first serve process that we have developed. Completion of the form does not guarantee that your patient will receive the antibody treatment. Patients that meet criteria will receive a phone call to be scheduled. Patients that do not meet criteria, or if capacity is reached, will not receive notification from Mount Nittany Health. View the form here.