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Ketamine Wellness Centers
Ketamine Treatments Phoenix, Arizona
Locations in AZ, CO, IL, MN, TX, WA, FL
855-KET-WELL
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Home
About
Core Values
Why KWC?
Meet The Team
How To Get Started
Cost, Financing, & Insurance
Patient Testimonials
FAQ / Frequently Asked Questions
Treatments
Depression
Neuropathic Pain & Chronic Pain
Post-Traumatic Stress Disorder (PTSD)
Obsessive Compulsive Disorder (OCD)
Suicidality
Insurance
Locations
Phoenix-Mesa, Arizona
Tucson, Arizona
Denver, Colorado
Seattle, Washington
Dallas-Fort Worth, Texas
Houston, Texas
Chicago, Illinois
Minneapolis–St Paul, Minnesota
Jacksonville, Florida
Patient Support
Facilitated Treatment Support
Meetups & Education
KetWell Therapy Products
Nutraceutical Supplements
KetWell Inspiration Partner Program
Facebook Patient Support Group
Patient Referral Program
Hero Discount
Travel Discounts
Blog
KWC Podcast
All Podcasts
A Closer Look at Spravato (Esketamine)
Fact or Fiction?
Ketamine Success & Insights
Healthy Living & Mental Health
Press, Media, Company Announcements
“A Hero’s Journey: Mallory’s Story”
Forms
I. Intake Form: Patient Intake
II. Intake Form: Ketamine Information Package
III. Intake Form: Depression Index
Medical Records Release & Request
Authorization for Communication
Make a Payment
Patient Referral Program, Earn $100!
Refer Your Patient To Us
Contact Us
Home
About
Core Values
Why KWC?
Meet The Team
How To Get Started
Cost, Financing, & Insurance
Patient Testimonials
FAQ / Frequently Asked Questions
Treatments
Depression
Neuropathic Pain & Chronic Pain
Post-Traumatic Stress Disorder (PTSD)
Obsessive Compulsive Disorder (OCD)
Suicidality
Insurance
Locations
Phoenix-Mesa, Arizona
Tucson, Arizona
Denver, Colorado
Seattle, Washington
Dallas-Fort Worth, Texas
Houston, Texas
Chicago, Illinois
Minneapolis–St Paul, Minnesota
Jacksonville, Florida
Patient Support
Facilitated Treatment Support
Meetups & Education
KetWell Therapy Products
Nutraceutical Supplements
KetWell Inspiration Partner Program
Facebook Patient Support Group
Patient Referral Program
Hero Discount
Travel Discounts
Blog
KWC Podcast
All Podcasts
A Closer Look at Spravato (Esketamine)
Fact or Fiction?
Ketamine Success & Insights
Healthy Living & Mental Health
Press, Media, Company Announcements
“A Hero’s Journey: Mallory’s Story”
Forms
I. Intake Form: Patient Intake
II. Intake Form: Ketamine Information Package
III. Intake Form: Depression Index
Medical Records Release & Request
Authorization for Communication
Make a Payment
Patient Referral Program, Earn $100!
Refer Your Patient To Us
Contact Us
Make a Payment
For services rendered by Ketamine Wellness Centers
Account Information
For the individual submitting payment
Name
*
First
Last
Email
*
Phone
*
Patient's Name
If the individual receiving treatment is not the same person who is submitting payment through this form.
First
Last
Which treatment are you paying for?
Please select from the treatment options below and make sure to select the quantity you are paying for, as well.
Screening Fee
The $125 fee required for KWC to conduct your medical and/or psychological screening with our intake professionals.
Price:
$125.00
Quantity:
Mental Health Treatment
The $449 fee for a single ketamine treatment for a mental health condition.
Price:
$449.00
Quantity:
Pain Treatment
The $899 fee for a single ketamine treatment for a chronic pain condition.
Price:
$899.00
Quantity:
Prolonged Pain Treatment
The $1200 fee for a prolonged ketamine treatment for a chronic pain condition.
Price:
$1,200.00
Quantity:
Facilitated Treatment Support Program
The $150 fee required to participate in the Facilitated Treatment Support program. This will cover six 30 minute sessions with the KWC Health & Wellness Coordinator and a FTS guidebook.
Price:
$150.00
Quantity:
Total
$0.00
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