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Laura A Dozen Center Therapy Clinic: 1802 W. Park side Lane, Phoenix, AZ 85027 UCP Downtown East Therapy Clinic Ability 360: 5035 E. Washington St., Ste 108, Phoenix AZ 85034 UCP Therapy Referral

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Start by providing your personal information, including your name, contact information, and address.

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Next, fill in the details about the therapy session you are scheduling, such as the date and time of the appointment.

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Indicate the type of therapy you are seeking and any specific concerns or goals you have for the session.

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Provide information about your medical history, including any previous therapies or treatments you have undergone.

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If applicable, include details about your insurance coverage and any authorization required for the therapy.

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This form helps the center gather important information about the individual's needs, preferences, and medical history, which can aid in determining the most suitable therapy for them.

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Whether it's for individuals dealing with mental health issues, relationship problems, or personal growth and development, completing this form can assist the center in providing personalized and effective therapy services.

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