Forms
The evaluation process to become a patient at Mind Body Centers is as follows:
- Complete the Patient Intake form
- Read & sign the Ketamine Information Package
- Complete the Depression Index
Required Intake Forms
I. Patient Intake Form
II. Ketamine Information Package
III. Depression Inventory Assessment
Other Forms
Medical Records Release & Request
Allows MBC to request medical records on your behalf.
Authorization for Communication
Required if patient wants someone else to communicate with MBC on their behalf.
Referral Program