PATIENT PORTAL

It’s your turn to blossom. Everything you need to begin your journey is right here.

PATIENT PORTAL

Thank you for choosing Evansville Ketamine Center. We are on your team, ready to help you achieve health and happiness.

Below are all of the forms you will need to complete prior to beginning ketamine treatments at our clinic. Please contact us with any questions!

FORMS TO COMPLETE ONLINE

The following forms may be completed and submitted via our secured patient intake portal. Just click the name of the form to complete and submit your information.

Medical History Form

Please tell us about your medical history so we can better serve you.

Payment & Cancellation Policy

Please review and agree to our payment & cancellation policy.

Privacy Policy

Please review and agree to our privacy policy.

Consent to Electronic Communication

Please agree to receive communication from our clinic via email and text.

FORMS TO REVIEW ONLINE

The following forms may be reviewed online, or printed and provided to your primary care physician to complete and return to us. Instructions for each form are noted below.

Informed Consent to Ketamine Treatment

Please review important information about ketamine treatments prior to your initial appointment.

Acknowledgement of Ongoing Care

Please provide this form to your referring physician and ask them to complete and the return the form to us.