Forms

New patient intake: [ pdf file ] Please fill out, sign, and submit via fax or e-mail before your first visit. See page 5 for current fee schedule.

Ketamine informed consent: [ pdf file ] Required only for patients interested in ketamine assisted psychotherapy.

QIDS-SR16: [online form] or [ pdf file ] AKA The Quick Inventory of Depressive Symptomatology 16-item Self-report, for quantifying and tracking depressive symptoms over time.