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Axis for Autism

For providers

Refer a patient

For referring offices sending a patient to Axis for Autism. Complete the form below and our intake team will follow up within one business day.

Diagnostic Evaluation Referral ABA Therapy Referral Referral Process

Before you start.

Choose the form for the service you are referring for: a diagnostic evaluation, or ABA therapy. Each asks for the information below. You can also fax a referral to (602) 883-7254, email one to referrals@axisforautism.com, or call the intake line that matches the service you are referring for.

  • Patient and guardian details

    Name, date of birth, contact phone, ZIP code, and the guardian’s relationship to the patient.

  • Insurance

    Plan, subscriber name, group number, and ID number. Add a secondary plan if the family carries one.

  • Clinical context

    Reason for referral and presenting concerns, any past diagnoses, and the date of the last physical exam.

Referring on behalf of an agency, school, or as a case manager rather than a clinical practice? Use the community referral form.

Which service are you referring for?

Questions about a referral?

Our intake team responds within one business day. Call the line that matches the service you are referring for.

Diagnostics (602) 888-8882 ABA (602) 888-8883