- 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)

Fill them out and bring them with you to your first appointment

861 North 980 West Orem, UT 84057

385-262-4135

Promise Medical