AUTHORIZATION TO DISCLOSE HEALTH INFORMATION PLEASE COMPLETE THIS AUTHORIZATION FORM IN THE EVENT THAT WE NEED TO DISCLOSE YOUR HEALTH INFORMATION TO THOSE YOU DEEM ACCEPTABLE MEDICAL HISTORY FORM • PRIVACY POLICY • PAYMENT & CANCELLATION POLICY • CONSENT TO ELECTRONIC COMMUNICATION • INFORMED CONSENT TO KETAMINE TREATMENTS • ACKNOWLEDGMENT OF ONGOING CARE A KETAMINE FOR DEPRESSION A ANXIETY TREATMENTS A PTSD TREATMENTS A KETAMINE TREATMENT FOR EATING DISORDERS A BIPOLAR DISORDER TREATMENTS A POSTPARTUM DEPRESSION TREATMENTS A KETAMINE FOR TREATMENT RESISTANT DEPRESSION A KETAMINE FOR CHRONIC PAIN A KETAMINE INFUSION THERAPY FOR NERVE PAIN A MIGRAINE MEDICINE ×
