Referral

Our cutting-edge Ketamine infusion therapies provide rapid, lasting relief from depression, anxiety, PTSD, OCD, and more.

Provider Referrals for IV Ketamine Therapy and more at Ketamine is Hope!

Feel free to give us a call or send us an email with your questions or comments.

Have a question? Leave us a message and we’ll get back to you soon. Please don’t submit sensitive medical information, we’ll get that when we talk to you.

Patient First Name *

Patient Last Name *

Patient Phone Number *

Patient Birth Date *

Name of Referring Physician *

Name of Practice *

Address of Practice *

Email address *

Phone Number of Practice *

Reason for Referral *

Please select at least one option.

I allow this website to store my submission so they can respond to my inquiry. *

Sorry, we were not able to submit the form. Please review the errors and try again.

How to pay for our services

We offer transparent pricing and convenient payment processes!

At Ketamine Is Hope, we offer convenient payment options for our services. You can choose to pay for your treatment with cash or explore financing options through Advance Care. We understand that each individual's financial situation is unique, and we are committed to helping you access the care you need. If you prefer to pay in cash, we accept cash payments for our services.

Alternatively, if you would like to explore financing options, you can apply for financing through Advance Care by visiting their website at https://advancecarecard.com/. We are here to support you in finding the best payment option for your needs.

Still Waiting for the Fog to Lift? We Can Illuminate the Path Forward.

When you feel lost in a fog of depression, anxiety, OCD or PTSD, it's hard to see any light ahead. But we can envision your brighter future.

Call 574-544-2283