FOR PATIENTS

Please complete and submit the following forms:

Tell us a little about your medical history so we can provide the highest level of personalized care.

Please review and agree to our payment and cancellation policy.

Please review and acknowledge your understanding of our privacy policy.

Please agree to receive communication via email and other electronic methods.

Please review or print these documents, and return them to our clinic.

Please provide this form to your referring physician and have him or her return the document to our clinic prior to your first ketamine infusion.

Please review this information. We will ask you to acknowledge your understanding of this information prior to your first ketamine infusion.