Language
  • English (US)
  • Español
  • Confidential Client Information

    Please fill in the form below
  • We are excited to start your service and we welcome you to our Therapy Matters, Inc. family!

    Please follow us on our social media pages and participate in surveys and family events - we are here for you!

    If any special accommodations can be made, TMI will go above and beyond to try and accommodate our special families.

    Consistent with the legacy of TMI's founder, “Live in the moment and BE the miracle!”

  •  -
  •  -
  •  -
  • In case of Emergency

  •  -


  • DDD Information

  •  -
  •  -
  •  -
  • Medical Information Release

    I hereby authorize the release of any information, including the diagnosis and the records of any treatments or examinations rendered, to my insurance company or companies, or other healthcare agencies.  I also authorize the release of medical records or copies of such and request that they be transferred to Therapy Matters, INC. 1334 E. Chandler Blvd. STE 5A01 Phoenix, AZ 85048

  • Clear
  •  -  -
    Pick a Date  :
  • HIPAA

  • (This HIPAA Form is designated for the patient named above.) 

    I hereby authorize use or disclosure of protected health information about me as described below.

    The following person and/or company may receive disclosure of rotected health information about the above named patient.

  • Clear
  •  -  - Pick a Date  :
  •  
  • Should be Empty: