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  • Patient Information & RX

Patient information form

To help serve you better, please print, fill out,

and return the form to us as soon as possible either

by fax 602-957-2562 

or

email to barbaras.boutique.phoenix@gmail.com

We look forward to seeing you.

Prescription form

PLEASE BRING A SIGNED PRESCRIPTION FROM YOUR PROVIDER

TO YOUR APPOINTMENT. 

Printable copy available below the Patient Information Section.


Patient Information

Patient Information

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

We look forward to seeing you at your appointment.

We love our customers, so feel free to visit during normal business hours.

Patient Information Form for Website-Patient Use (pdf)

Download

LETTER OF MEDICAL NECESSITY AND PRESCRIPTION FORM (pdf)

Download

1131 E. highland Ave Suite#2 Phoenix, AZ 85014

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