861 North 980 West Orem, UT 84057

385-262-4135

Promise Medical

- Ketamine Clinic Forms -

In order for Promise Medical to administer Ketamine Muscle Injections (KMI) we need to gather some health background information from you. After the documentation is completed we will have a consultation visit for a physical screening and to review your medical history.

Download All 3 PDF's to your Desktop

#1.

Informed Consent for Ketamine

#2.

Eligibility Screening for Ketamine

#3.

Hamilton Depression Rating Scale (HAM-D)

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#1.
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#2.
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#3.
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