Patient Intake Portal
Everything you need to begin your journey towards health and wellness is right here. Please complete the below forms prior to your initial ketamine infusion appointment.
Forms to be completed online:
Medical History Form
Please tell us about your medical history
Privacy Policy
Please review & agree to our clinic’s Privacy Policy
Payment & Cancellation Policy
Please acknowledge your receipt and understanding of our cancellation policy.
Consent to Electronic Communication
Please review & agree to receive communication for our clinic via non-secured electronic methods.
Forms to be completed online:
INFORMED CONSENT TO KETAMINE TREATMENTS
Please review this important information about ketamine infusion therapy prior to your first infusion.
ACKNOWLEDGEMENT OF ONGOING CARE
Please provide this form to your primary or mental health care provider and ask them to complete and fax the form back to our office.
