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Acknowledgement of Ongoing Care

Acknowledgement of Ongoing Care

This form needs to be completed by your referring physician, primary care physician, or mental healthcare provider. Please direct your physician to this form and request that they submit it prior to your initial ketamine infusion. If your physician has any questions or concerns, we invite him or her to contact us via email at info@ketaminegreaterboston.com or by calling +1 617.964.8200. Thank you!