Patient Portal | New Patient Intake Forms

New Patient Intake Forms

Please complete these forms and review our policies prior to your first appointment at our Omaha ketamine clinic.

Forms to Complete Online

Medical History Form

Please tell us a little about your medical history.

Privacy Policy

Please review our privacy policy.

Cancellation Policy

Please review our cancellation policy.

Consent to Electronic Communication

Please review our policy about communicating with our ketamine clinic via email and text.

Forms to Review & Print

Please review our Treatment Consent form—we will have you sign this document upon arrival for your first appointment. The Acknowledgement of Ongoing Care form can be printed and provided to your primary care doctor or mental healthcare practitioner, to be completed and returned to our clinic.

Treatment Consent

Please review our informed treatment consent policy.

Acknowledgement of Ongoing Care

Please print this document and provide it to your primary care physician or mental healthcare provider.