Phone:

385-262-4135

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- 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 as well as go over your medical history.

Then we will take some time to educate you about the amazing journey & experiences you may have while you are on your way to a new healthy YOU!

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)

* Some of the forms we will have you physically sign during the consultation *

Fill out your contact information.

After filling out all 3 PDF's Upload each of them here.

#1.
Max File Size 15MB
#2.
Max File Size 15MB
#3.
Max File Size 15MB