Welcome Providers to Our Clinician Referral Form Section!
Update: June 1, 2020: Due to coronavirus, we are currently not taking new patients as we accommodate our backlogged of existing patients. Thank you for your understanding. Thank you for taking the next step in referring your patients to our Services. Our group of compassionate Anesthesiology Providers want to assure your practice we emphasize on collaborative, patient-centered care. Therefore, we strive to compliment patient and practitioners goals for a synergistic, customized plan of care. We thank you for your time and look forward to help. -DC Ketamine Clinic
Prerequisite: Completion of Clinician Referral Form (online or download below) is required prior to the initial Anesthesia Consultation. Additionally, a Comprehensive History and Physical Examination completed within twelve (12) months of Anesthesia Consultation is required priorto initial Anesthesia Consultation. These two items are required in order to confirm diagnosis, determine whether Ketamine and/or Lidocaine infusion therapy is appropriate for you, and to facilitate any insurance reimbursement you may be eligible to receive following your submission of documentation to your insurers.