Please fill out the following information and email us before your first treatment.

Our email: support@ketaminehaven.com

I certify that the above information is true and accurate. I authorize the release of any medical or other information necessary to process a claim or continue medical treatment. I acknowledge that I am responsible for the payment of my treatment.

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If you have any questions, don't hesitate to call our clinic.

Ketamine Haven Clinic

(818) 817-6542

support@ketaminehaven.com

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