New Patients:

     Please fill out these three forms and submit them online (or print and fax them if you prefer to (303) 484-4087) via our secure server. This is encrypted and HIPAA compliant to ensure your confidentiality. After we receive these forms, we will contact you to proceed further.

Referring Providers:

     Please fill out the referral form if you are referring a patient (and/or call us at (303) 823-4882):
    Providers may also use this form to confirm that a patient has been under their care:

Existing Patients: Please fill out and sign the Pre-Infusion Questionnaire, as well as the Ketamine Therapy After-Infusion Instructions the morning of your next infusion. You may familiarize yourself with the Informed Consent Form as well, but you should not sign it until you have discussed the procedure with Dr. Grindle, and had your questions explained, just before your infusion.

Forms

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