Skip to content
Get Started Today
Financing Options Available
Monday – Friday 9 AM – 6 PM
Need to Refer a Patient?
Search:
SEARCH
Ketamine Wellness Centers
Ketamine Treatments Phoenix, Arizona
Locations in AZ, CO, 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
Phoenix-Mesa, Arizona
Tucson, Arizona
Denver, Colorado
Minneapolis–St Paul, Minnesota
Dallas-Fort Worth, Texas
Seattle, Washington
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”
Patient Support
Patient Coaching
KetWell Patient Connect Groups
Depression & Pain Support Group
Facebook Patient Support Group
KetWell Inspiration Partners
Nutraceuticals & Supplements
Referral Program
Hero’s Discount (Military & 1st Responders)
Travel Discounts
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
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
Phoenix-Mesa, Arizona
Tucson, Arizona
Denver, Colorado
Minneapolis–St Paul, Minnesota
Dallas-Fort Worth, Texas
Seattle, Washington
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”
Patient Support
Patient Coaching
KetWell Patient Connect Groups
Depression & Pain Support Group
Facebook Patient Support Group
KetWell Inspiration Partners
Nutraceuticals & Supplements
Referral Program
Hero’s Discount (Military & 1st Responders)
Travel Discounts
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
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
Go to Top
THE LATEST NEWS AND SPECIALS
