Isha Health patient referral form

If you are a clinician and have a patient who you would like to refer to Isha Health for ketamine-assisted psychotherapy or ketamine medication, please feel free to fill out the form and upload it here through our secure HIPAA-compliant uploader.


Please note at this time we are only treating patients who live in AZ, CA, CO,  FL, NY and WA.

Step 1

Please download this referral form and fill it out.

DOWNLOAD THE REFERRAL FORM

Step 2

Please upload the form and/or clinical summary of the patient through this secure uploader.

UPLOAD YOUR REFERRAL FORM