Medical Referral Form

Medical Professional Referral Form

Lily’s Pad is a hyperclean, indoor play facility for children who are immunocompromised or considered vulnerable to illness due to a medical condition.  Our facility is free to any qualifying child and their immediate family.  If you have a child that you would like to recommend for play, please fill out the form below. 

This form can also be downloaded as a PDF and filled out.  Please email the completed form to [email protected] or mail to: 3320 S. Priest Drive Suite 4, Tempe, AZ 85282.