Forms

For your first visit please bring with you:

  • A completed version of the new patient intake (see below)
  • Current or recent prescription medications, ideally in their original bottles
  • Recent lab results and/or hospital discharge summaries (or have them faxed over to the number below)

New patient intake: [ pdf file ] or [ word document ] 
Intake form for new patients. Also contains the current fee schedule. Please fill out, sign, and bring with you to your first appointment. 

Ketamine informed consent[ pdf file ] or [ word document ] 
For patients interested in ketamine infusions or injections, treatment resistant depression, PTSD, and more.  Only needed for those interested in starting ketamine treatments.