Ketamine for Mood Disorders

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  • Treatments
    • Depression
    • Bipolar Disorder
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    • Posttraumatic Stress Disorder
  • FAQ’s
    • What is Ketamine
    • What is esketamine or Spravato?
    • How does Ketamine work?
    • Is it safe?
    • Is it legal?
    • What are the side effects?
    • How long do the results last?
    • Is this covered by insurance?
    • How Much Do Treatments Cost?
    • What payment forms are accepted?
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Awakenings Ketamine Center Forms

 


Informed Consent for Intravenous Ketamine

Completed by the client after consultation for intravenous ketamine therapy


Medical History Form

To be completed by the client prior to the first treatment


Referral Form

May be used by mental health provider or primary care physician to initiate contact


Medical Records Release

Please provide completed form to your current or previous ketamine clinic


New Patient Privacy Practices Notice

For review

Contact Info

© 2019 Awakenings Infusion Center of North Carolina | 500 Holly Springs Rd. Suite 106, Holly Springs, NC, 27540 | 919-285-3222 | staff@ncawakenings.com

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