Important Information & Physician Forms

Please review our Informed Consent to Ketamine Infusions form, as you will be asked to sign this at our clinic prior to your first appointment. The Acknowledgement of Ongoing Care form may be provided to your referring physician and faxed back to our clinic.

Acknowledgement Of Ongoing Care

Please provide this form to your referring physician and ask him/her to fax the completed form to our clinic.

Forms To Be Completed Online

Please complete and submit the following forms prior to your first ketamine infusion:

Mediacal History Form

Tell us about your medical history so we can best meet your needs.

Privacy POlicy

Please review and agree to our privacy policy.

Pregnancy Waiver

Please sign our pregnancy waiver electronically.

Informed Consent To Ketamine Treatmentss

Please review this information prior to your initial appointment.

 

Payment & Cancellation Process

Please review and agree to our Payment & Cancellation policy.

Consent To Electronic Communication

Please review our electronic communication policy and agree to receive emails and/or text messages from our clinic.

Treatment DownPayment

Please make advanced payments online via our secured e-payment platform.

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Could Ketamine Infusions Help You Renew Your Life?

Ketamine infusions help 70% of patients hit the reset button and begin living with happiness once again. Find out if ketamine for depression is the right solution for you or a loved one. Request your free consultation today.

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Team of Professionals

Samanta Crane

Internist, General Practitioner

Working since 1988

Ostin Green

Internist, Emergency Physician

Working since 2002

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