Ketamine Therapy Consultation Form

Streamline Your Ketamine Therapy Consultations with Paperform

If you're running a ketamine therapy clinic or mental health practice offering innovative treatment options, you know that thorough patient assessment is critical. This Ketamine Therapy Consultation Form is designed specifically for healthcare providers who need to efficiently gather psychiatric history, evaluate treatment resistance, and determine patient eligibility for ketamine-assisted therapy.

Why This Form Works for Mental Health Practitioners

Ketamine therapy represents a breakthrough treatment for treatment-resistant depression, PTSD, anxiety disorders, and other mental health conditions. However, proper patient screening is essential for safety and efficacy. This template collects all the critical information you need in one organized, professional form:

• Comprehensive psychiatric history including current diagnoses and previous treatments
• Treatment resistance assessment to identify ideal candidates
• Medical screening for contraindications and safety considerations
• Referral tracking to understand your patient pipeline
• Contact and demographic information for seamless onboarding

Perfect for Growing Mental Health Practices

Whether you're a psychiatrist, mental health clinic, or wellness center offering ketamine therapy, this form gives patients a clear, compassionate way to share their story while ensuring you have the clinical information needed for informed decision-making. The professional design helps establish trust from the first interaction, and the structured format means you can review submissions quickly and schedule appropriate follow-ups.

Automate your workflow with Stepper: Connect this form to Stepper to automatically route submissions to your clinical team, send personalized follow-up emails based on eligibility criteria, update your practice management system, and trigger appointment scheduling—all without manual data entry.

Add eSignatures with Papersign: Once you've reviewed a consultation and decided to move forward, use Papersign to send consent forms, treatment agreements, and HIPAA authorization documents for secure electronic signature, keeping everything connected to the original intake submission.

Built with Paperform's intuitive form builder, this template is fully customizable to match your practice's protocols, branding, and specific screening requirements. Trusted by healthcare providers worldwide, Paperform offers SOC 2 Type II compliance and robust security features to protect sensitive patient information.