Request Appointment

Download Magnolia Personalized Medicine Forms

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

Medical Intake Form


Health Information Sign Form

Thank you for choosing us:

First appointment is usually 1 hour because we have to review the medical history and discuss what you expect to achieve health wise.

  • Please download and complete the Medical Intake forms prior to your appointment.
  • or medical aesthetics patients please complete this form.

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

Please visit the Medicinary page for Alternatives to Drugs. Current patients receive 10% off of purchase.

Open Hours:

By appointment only.

Foreign Languages Welcome:

Spanish, German, Italian, French, Portuguese


17505 N 79th Ave
Glendale AZ 85308
Suite 213

Call Us

Fax: 844-413-9024

Email Us

Privacy Policy


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