Ketamine Questions

Please complete the form below to request an appointment, and our intake team will reach out to you soon.

Request KAP Appointment

If you are interested in starting Ketamine-Assisted Psychotherapy, please provide the information below and our Intake Team will reach out within 24 hours.

Personal Information

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Client Address

General Disqualifying Criteria

Insurance Information

In which state are you located?
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Policyholder Address
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Max. file size: 40 MB.

Therapy Needs

Which office(s) would you prefer to attend?
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