PHYSICIAN'S REFERRAL

  • For referrals, please contact our office at 480-508- 7566.
  • Please provide signed orders for an evaluation for treatment.
  • Our staff will verify insurance benefits.
  • Client’s caregiver/parent will be reached by phone to schedule an admission/intake.
  • After the admission, the office scheduler will schedule an initial evaluation with the family.
  • Based on the results of that evaluation, the evaluating therapist will recommend the frequency of services in a Plan of Care to be approved by the PCP.
  • 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.

 

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.