IV Hydration Therapy

MEDICAL HISTORY FORM

Please fill in the following medical history information.  Once you submit, you will be taken to a page to review your information and then electonically sign our IV Hydration Therapy Informed Consent, Privacy Policy, Payment & Cancellation Policy, and Electronic Communication Policy.

KETAMINE INFUSION THERAPY MEDICAL HISTORY FORM  |  ACKNOWLEDGEMENT OF ONGOING CARE   |  PRIVACY POLICY  |  PAYMENT & CANCELLATION POLICY  |  ELECTRONIC COMMUNICATION POLICY  |  IV HYDRATION THERAPY FORMS  | INFORMED CONSENT TO KETAMINE TREATMENT |  INFORMED CONSENT TO IV HYDRATION THERAPY  |  PAYMENT FOR SERVICES