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Intake/ Referral Forms

Our staff take a commonsense approach to obtaining treatment, keeping the process as simple as possible is our goal.

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Simplicity at its best!

We look forward to

welcoming you soon!

What do you need to do?

Complete an Intake/ Referral form – Complete the form online and submit via email or you can bring it with you.

Can’t fill the form in?

That’s ok, you can do it when you arrive! One of our Intake team can help you.

Do not have AHCCCS Insurance?

One of our Intake Team can make the application on your behalf.

Prefer to pay cash?

We can confirm the cost before you commit to anything!

What services can I get?

Once we have the completed form, one of our Intake Team will be able to let you know!

Want more information?

Call us at 602-626-8112

or submit the intake form

to intake@axiomcareofaz.com

Start Forging Your Own Path Today!

Home Contact Form

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Corporate Office

3030 N Central Ave, Suite 506
Phoenix, AZ 85012

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Office Hours

M-F: 9am - 5pm
S-S: Closed

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Call Us

(602) 626-8112

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