Forms

Please fill out, sign, and submit the new patient intake, via fax or e-mail, before your first visit. Tip: to complete a PDF form electronically you can use Sejda, a third party online PDF editor (works on mobile devices), or open the link via Firefox, a not for profit web browser (this functionality only available from laptop or desktop).

New patient intake: [ pdf file ] See page 5 for the current fee schedule.

Ketamine informed consent: [ pdf file ] Required for those receiving ketamine assisted psychotherapy.

QIDS-SR16: [online form] The Quick Inventory of Depressive Symptomatology 16-item Self-report, for quantifying and tracking depressive symptoms over time. Please fill out before initial visit.