Awakenings Ketamine Center Forms

 


Informed Consent for Intravenous Ketamine

Completed by the client after consultation for intravenous ketamine therpy


Spravato – Patient Enrollment Form and Informed Consent

Completed by the client and clinic after consultation for nasal esketamine therapy


Medical History Form

To be completed by the client prior to consultation if possible


Referral Form

Please provide to your mental health provider or primary care physician for completion


Medical Records Release of Information

Please provide completed form to your mental health provider or primary care physician