In order to start the process of becoming a new patient at Desert Ketamine Clinic, please fill out the New Patient Form. This is an electronic HIPA compliant form that will tell us a little bit more about your medical history and current/past treatment strategies. Once this form is received, Dr. Munk may call to discuss your treatment options and to schedule a treatment plan that will suit your individual needs.

New Patient Form – Fill Out Online

Additionally, for patients seeking treatment specifically for a mental health diagnosis (depression/anxiety/ptsd), Desert Ketamine Clinic would also like to ensure that you have a current relationship with another health care provider that knows your mental health history and can confirm your current diagnosis and treatment strategies. This may be a psychiatrist, psychologist, family/internal medicine physician, or other qualified mental health care provider. Please download and print the following form. You must then sign it and write in the name/contact information of your other provider. Please email, fax, or hand-deliver this form to their office. The “Authorization to Release Medical Records” form is a signature release that will ask your other provider to send Desert Ketamine Clinic a copy of your recent medical records. Once these records are received by our clinic, we can schedule you for your first treatment. It may help to contact them by phone to ensure that they received the form and request that they expedite faxing your records to or office.

Authorization to Release Medical Records – Download and Print

If you do not have AdobeReader® installed on your computer, Click Here To Download.