Pre-Screening & Intake Forms

KETAMINE INFUSION PRE-SCREENING & INTAKE FORMS

Prior to beginning your ketamine infusion therapy, it is important for us to understand and evaluate your level of depression and/or anxiety. This helps us identify any other conditions that may complicate your treatments, or render them ineffective.

Please review our Privacy Practices and complete the following forms prior to your first treatment:

ketamine infusion therapy

Acknowledgement of Ongoing Care

To be completed by a referring physician or mental healthcare provider

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CONTACT KETAMINE GREATER BOSTON

Complete the brief form below to contact our Boston area ketamine clinic and learn more about how this innovative depression treatment could change your life.

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KETAMINE CLINIC LOCATION

109 Highland Ave, Suite 204
Needham, MA 02494

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