Patient Intake Forms

Your journey towards health & wellness begins here

FORMS TO BE COMPLETED ONLINE

Please complete the following intake forms prior to your appointment:

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Medical History Form

Tell us about your medical history, so we can effectively and safely serve you.

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Privacy Policy

Please review and agree to our privacy policy.

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Payment & Cancellation Policy

Please review and agree to our payment and cancellation policy.

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Consent to Electronic Communication

Please agree to receive communication via electronic means.

FORMS TO BE REVIEWED ONLINE AND/OR PRINTED

Please review the following intake forms prior to your initial ketamine infusion appointment, or print and provide the forms to your referring anesthesia provider:

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Informed Consent to Ketamine Treatments

Please review this information prior to your initial appointment.

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Acknowledgement of Ongoing Care

Please print this form and provide it to your referring anesthesia provider.