x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x

For Providers

Thank you for your confidence in our clinic and entrusting your patient into our care. The following are a couple of items that we would like for you to know prior to sending us a referral:

  • We will provide you with regular updates regarding your patient’s care and their response to ketamine therapy.
  • Based on your patient’s response to treatment, they may be able to reduce or discontinue many of the medications that they are currently taking. Since ketamine is a supplemental therapy, we will leave the titration of any medications to your discretion.

To send us a referral, please fill out the following form and fax it to us at (775) 432-1002.

- Please also include the patient’s most recent clinical documents, including SOAP notes and lab results.



Referral Form


Thank you again for your referral and we look forward to working with you in the future.


- RADIANCE KETAMINE CLINIC

Have questions regarding patient referrals?