Paperwork Needed for Consultation

Please have the following 3 documents completed by the time of your consultation.  You can bring these with you or email/fax them to the office ahead of time.  

Paperwork Needed Prior to Infusions

Please review the following documents regarding your first infusion, consent, financial information, cancellation policy, and discharge instructions.  These documents will also be reviewed at your consultation and signed at that time. 

First Appointment Information PAIN (pdf)

Download

Hodges - Consent Chronic Pain (pdf)

Download

Hodges - Consent Dep:PTSD (pdf)

Download

Hodges - First Appointment Information (pdf)

Download

Ketamine Cancellation policy (pdf)

Download

Hodges - DISCHARGE INSTRUCTIONS Updated 1.23.17 (pdf)

Download

Financial Agreement - IKS (pdf)

Download

Ins Documentation Policy (pdf)

Download

Sample invoice for pain infusion - for Insurance (pdf)

Download

Sample Invoice for mental health infusion - for Insurance (pdf)

Download

Thinking of starting a ketamine practice? My 30-page informational document can help you decide.