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Ketamine Wellness Centers
Ketamine Treatments Phoenix, Arizona
Locations in AZ, CO, IL, MN, TX, WA
855-KET-WELL
THE LATEST NEWS AND SPECIALS
Home
About
How To Get Started
Why KWC?
Cost, Financing, & Insurance
Meet The Team
Patient Testimonials
FAQ / Frequently Asked Questions
Treatments
Depression
Neuropathic Pain & Chronic Pain
Post-Traumatic Stress Disorder (PTSD)
Obsessive Compulsive Disorder (OCD)
Suicidality
Locations
Chicago, Illinois (now open!)
Dallas-Fort Worth, Texas
Denver, Colorado
Minneapolis–St Paul, Minnesota
Phoenix-Mesa, Arizona
Seattle, Washington
Tucson, Arizona
Patient Support
Facilitated Treatment Support
KetWell Therapy Products
Nutraceutical Supplements
KetWell Inspiration Partner Program
Facebook Patient Support Group
Hero Discount
Travel Discounts
Blog & Podcast
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”
Clinic Forms
I. Patient Intake Form
II: Ketamine Information Package
III: Depression Index
Medical Records Release & Request
Authorization for Communication
Make a Payment
Refer a Patient, Earn $100
Contact Us
Home
About
How To Get Started
Why KWC?
Cost, Financing, & Insurance
Meet The Team
Patient Testimonials
FAQ / Frequently Asked Questions
Treatments
Depression
Neuropathic Pain & Chronic Pain
Post-Traumatic Stress Disorder (PTSD)
Obsessive Compulsive Disorder (OCD)
Suicidality
Locations
Chicago, Illinois (now open!)
Dallas-Fort Worth, Texas
Denver, Colorado
Minneapolis–St Paul, Minnesota
Phoenix-Mesa, Arizona
Seattle, Washington
Tucson, Arizona
Patient Support
Facilitated Treatment Support
KetWell Therapy Products
Nutraceutical Supplements
KetWell Inspiration Partner Program
Facebook Patient Support Group
Hero Discount
Travel Discounts
Blog & Podcast
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”
Clinic Forms
I. Patient Intake Form
II: Ketamine Information Package
III: Depression Index
Medical Records Release & Request
Authorization for Communication
Make a Payment
Refer a Patient, Earn $100
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
Price:
$100.00
Quantity:
Mental Health Treatment
Price:
$500.00
Quantity:
Pain Treatment
Price:
$750.00
Quantity:
Total
$0.00
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THE LATEST NEWS AND SPECIALS
