PHYSICIAN'S REFERRAL

  • For referrals, please contact our office at 480-508- 7566.

  • Please provide signed orders for an evaluation and ongoing treatment.

  • Our staff will verify insurance benefits.

  • Client’s caregiver/parent will be reached by phone to schedule a phone or in-person intake.

  • After intake and insurance verification, the office scheduler will call to schedule an inital evaluation.

  • Based on the results of that evaluation, ongoing therapy sessions and frequency of services will be recommended.

  • The therapist and office staff will assist the family with scheduling appointments.

Download, print, and fill out the Physician's Referral Form.
(Link to form)

Or

Complete our online form below.

You may also fax your own referral form to our office at 928-212- 9014. Please note: If you choose Prescott Valley location, we do not offer OT services at that this time.

 

Physician's Name *
Physician's Name
Address
Address
Patient Name *
Patient Name
Services requested (choose one or more)
All information below MUST be provided by the physician so that an evaluation can be scheduled.