Request Appointment

Download Magnolia Personalized Medicine Forms

Please fax all forms to 844-413-9024. Do not send through email.

Medical Intake Form

HIPPA Form

Health Information Sign Form

Thank you for choosing us:

Initial visit is 90 minutes, follow up consultations are 60 minutes, 45 minutes.

  • Please download and complete the Medical Intake forms prior to your appointment.
  • You may bring the completed paperwork with you for your appointment or fax it

Have any questions or would you like to make an appointment? Use this form to get in touch. Your requests are confidential and secure.

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Please visit the Medicinary page for Alternatives to Drugs choices

Open Hours

By appointment only.

Foreign Languages Welcome:

Spanish, German, Italian, French, Portuguese

Location

17505 N 79th Ave
Glendale AZ 85308
Suite 213

Call Us
623-734-2473

Fax: 844-413-9024

Email Us

 

Privacy Policy

Medicinary

We accept all major credit/debit cards and health saving cards

Open Hours:

By appointment only.

Foreign Languages Welcome:

Spanish, German, Italian, French, Portuguese

Location

17505 N 79th Ave
Glendale AZ 85308
Suite 213/I

Call Us
623-734-2473

480-233-4373

Fax: 844-413-9024

Email Us

Privacy Policy

Medicinary

We accept all major credit/debit cards and health saving cards