To get started with therapeutic ketamine in an out-patient setting, the following forms are needed, at a minimum:
FOR INDIVIDUAL KETAMINE TREATMENT
Supplies List (medications & equipment)
Ketamine Treatment Intake Packet (includes medical & psychological history)
Preparation Instructions for Ketamine Treatment
Informed Consent for Ketamine Treatment
Individual Dose Record Form
Individual Payment Log
Release of Information (to talk with other medical/clinical providers, or to talk with family members)
Transportation Agreement Form
ADD FOR GROUP WORK
Group Session Record Form
Group Payment Log
OPTIONAL
Weight-Dose Chart
Reflection Questions