Request Services

HOME
Our Programs
Enrollment
- Preparing for your first visit
- Insurance Coverage for Therapy
Careers
- New Hire Reference
Contact Us
- Request Services
What's New!

Our Providers and Therapists
are not only compassionate people who love what they do, but are also experienced so you can rest assured your loved one is in capable hands.

To ensure our clients’ complete safety, our Providers and Therapists are CPR and First Aid certified and required to maintain clean driving records at all times, if transporting clients. In addition, all providers must pass an FBI background check and obtain a Class 1 Arizona Fingerprint Clearance Card, pass an APS/CPS background check, a Medicaid fraud check, and hold applicable licensure.

Feel free to call us directly or complete and complete the online form below and our Client Coordinator will contact you shortly.
We look forward to adding you to our Milestone family!

Please complete the form below.

* Indicates required field

Name *

Email *

Phone Number *

Location *

Chandler Tucson Teletherapy Telephonic Mesa Home based

Service(s) Requested *

Respite Habilitation Speech Therapy Occupational Therapy Physical Therapy Music Therapy Attendant Care Telephonic Therapy Tutoring

Billing *

DDD ESA Private Pay Other

How old is your child/ loved one needing services? *

Zip Code? *

Major Cross Streets? Or Teletherapy/Telephonic *

If you have a specific schedule request, please list below. *

Is there any additional information you would like us to know about your loved one, their needs, or your family? *

Preferred Therapy Appointment time *

Do you have a friend or family you would like to certify? (Respite and Habilitation only) *

Yes No

Submit

Are you interested in certifying a friend or family member to provide Respite and/or Habilitation for your loved one?
We can help! Please contact us at [email protected] to get the process started

Requirements:

* At least 18 years of age
* Article 9 Training
* CPR and First Aid
* Level One Fingerprint Clearance Card
* Vehicle Registration and Insurance (If Transporting clients)
* Attend HR Orientation

We can help your friend or family member obtain the necessary training to start today!

WEST MESA (previous Chandler clinic)
1830 S. Alma School Rd. Ste 122
Mesa AZ 85210
(480) 855-0474
Fax (480) 907-6855

Tucson Location:
205 W. Giaconda Way
Suite 135
Tucson AZ 85704
(520)-329-8830
Fax (520) 612-7892

request services