Other Clinic Forms:

MHWB practice consent form

https://www.cognitoforms.com/NotreDameBehavioral/mentalhealthwellnessboutiquenoticeofprivacypractices

Release of medical information from Mental Health Wellness Boutique to Notre Dame Behavioral Health

https://www.cognitoforms.com/NotreDameBehavioral/medicalrecordsreleasefrommhwbtondbh

Release of medical information from Notre Dame Behavioral Health to Mental Health Wellness Boutique

https://www.cognitoforms.com/NotreDameBehavioral/medicalrecordsreleasefromndbhtomhwb

Release of medical information from Mental Health Wellness Boutique to other offices

https://www.cognitoforms.com/NotreDameBehavioral/mhwbmedicalrecordsreleasefrommhwbtootheroffices

Release of medical information to self (Mental Health Wellness Boutique)

https://www.cognitoforms.com/NotreDameBehavioral/mhwbmedicalrecordsreleasetoselfform

What we offer

Services

Location

Mental Health Wellness Boutique
18001 N. 79th Avenue, Suite B48
Glendale, AZ 85308
Phone: 888-906-8301
Fax: 623-404-6602

Office Hours

Monday 9:30 am to 4:00 pm Tuesday 9:30 am to 4:00 pm Wednesday Closed Thursday 9:30 am to 4:00 pm Friday 9:30 am to 4:00 pm Saturday Closed Sunday Closed

Get in touch

888-906-8301