PREGNANCY QUESTIONNAIRE AND WAIVER
PLEASE REVIEW AND COMPLETE THE PREGNANCY QUESTIONNAIRE AND WAIVER
Receiving Ketamine and/or drugs during pregnancy may be harmful to a developing fetus. It is the policy of Vitalitas Denver, PC that women who are pregnant or breastfeeding or who may be pregnant should not undergo IV Ketamine Infusion.
If you are a woman who is or is breastfeeding, or if there is a chance you may be pregnant, please inform Vitalitas Denver staff immediately. You have the option of taking a pregnancy test in our office prior to your infusion.