Forms

New patient intake: [ pdf file ] Please fill out, sign, and submit via fax or e-mail before your first visit.

• For the current fee schedule, see page 5 of this form.

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

QIDS-SR16: [online form] The Quick Inventory of Depressive Symptomatology 16-item Self-report, for quantifying and tracking depressive symptoms over time. Please fill out before initial visit.