Find Out If You are a Candidate for Ketamine Treatment Do you suffer from depression? YesNo Have you been diagnosed with any of the following: Major Depression, PTSD, OCD, Anxiety, Bipolar Disorder? YesNo Do you have chronic pain? YesNo Have you been diagnosed with any of the following pain syndromes: Reflex Sympathetic Dystrophy (RSD), Chronic Regional Pain Syndrome (CRPS), Neuropathic Pain, Trigeminal Neuralgia, TMJ syndrome, chronic back/musculoskeletal pain? YesNo Have you been resistant to standard therapies, or intolerant of their side effects? YesNo Name (required) Email (required) Phone (required) By using this form you agree with the storage and handling of your data by this website in accordance with our Privacy Policy. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
