602-507-4209
First Name
Last Name
Name of Business
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Hours of Operation
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TTY
Address
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Email
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Physicians N/AAlternative and Complimentary MedicinePhysical Medicine, Rehab PhysiciansPhysician: PsychiatristPhysician: PhysiatristPhysician: SCI PCPPhysician :DermatologyPhysician: GastroenterologistPhysician: OrthopedicPhysician: PodiatristPhysician: NeurologyPhysician: DentistPhysician: AllergistPhysician: OB/GYNPhysician: NaturopathicPhysician: UrologistPhysician: PediatricsPhysician: Pain Management SpecialistNeurology PhysiciansNeurosurgery PhysiciansNutritional ServicesNeuropsychologistVision: Neuro-Opthamology/ Optometry
Government Programs N/AEmployment/ Vocational TrainingState and Federal AgenciesSocial Security/ Financial ServicesVeteran and Military ServicesMedical Insurance/ Assistance Programs: ACHHS, ALTCSLibrary ResourcesEducation Resources and SupportPrescription Medicine Discount Programs
Home Services N/ARespite CareSkilled Nursing FacilitiesAdult Day ProgramsHousing Assistance and Accessible Housing ListingsHome Health CareHome Care ServiceIndependent Living AgenciesResidential ServicesPersonal Care ResourcesPersonal Attendant CareHospice ServicesHome Modifications
Therapy and Support Services N/AService Animal ProgramsCognitive, Speech, Occupational, and Physical TherapyOccupational TherapySpeech TherapyPhysical TherapyAnimal (PET) TherapyArt and Music TherapyRecreational TherapyPsychotherapistCounseling and PsychologistsSupport GroupsFamily Resources and SupportVocational Rehab ProgramsSocial Recreational Programs: Including SportsCrisis InterventionRehabilitation Programs
Professional Services N/ALawyers, Accountants, Tax PreparersCase Management and Service CoordinationFinancial: Life Care and Special Needs PlanningAdvocacy for Services and Community InformationLegal Information
Durable Medical Equipment N/AAssitive TechnologyProviders of Durable Medical EquipmentWheelchair Related Resources
Transportation Solutions N/ADriving Evaluations and Re-trainingTransportation ServicesVehicle and Residential Modification Specialists
1. Are you familiar with the Arizona Spinal Cord Injury Association (AZSCIA)? N/AYESNO
2. Do you have someone in the office that is bilingual? If so, please list languages spoken
3. Would you like to receive our free monthly newsletter? N/AYESNO
4. Is your office wheelchair accessible and user friendly by persons with mobility impairments? N/AYESNO
5. Do you have previous experience working with individuals with a SCI (spinal cord injury)? N/AYESNO
6. Designated accessible parking? N/AYESNO
7. Does your office have accessible restrooms? N/AYESNO
8. Are there multiple locations? If so, please list below.
9. Would you like to provide any additional information about the services you provide?
Choose One I certify that all information provided as part of this application is true and correct to the best of my knowledge. Any certifications and licenses required of my profession have been obtained and are currently up to date. I give my consent to the Arizona Spinal Cord Injury Association to use this information provided herein for the purpose of resource considerations on the website and internal database.
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