Ketamine Referral Form

Ketamine Referral Form

You are about to initiate our online scheduling process.

This submission is an appointment REQUEST. Please be aware that our team will contact you to confirm your appointment.

We recommend utilizing your smartphone, as you will be prompted to photograph your current driver’s license or other government-issued photo identification, as well as your current insurance card. Ensure you have these documents ready as you proceed with the online scheduling.

For your initial online scheduling, you must fill out three consent forms, which will then be stored in your record for future appointments.
Additionally, it’s crucial to thoroughly fill out all sections of the health questionnaire. Neglecting any part of the online registration process may cause delays in scheduling your appointment.

Thank you for your patience and we look forward to your visit!

Continue

Ketamine Referral Form

You are about to initiate our online scheduling process.

We recommend utilizing your smartphone, as you will be prompted to photograph your current driver’s license or other government-issued photo identification, as well as your current insurance card. Ensure you have these documents ready as you proceed with the online scheduling.

For your initial online scheduling, you must fill out three consent forms, which will then be stored in your record for future appointments.

Additionally, it’s crucial to thoroughly fill out all sections of the health questionnaire. Neglecting any part of the online registration process may cause delays in scheduling your appointment.

Thank you for your patience and we look forward to your visit!

Continue