Forms / Cost

Cost of Treatment

Depression Treatment Cost:


Initial six ketamine infusions     $2850

Booster infusions     $475

All patients will need a single booster infusion every 4 to 6 weeks to keep depression symptoms controlled.

CRPS / RSD Treatment Cost:


$ 1800 per treatment which run 4-6 hours each.

Most patients will require between 5-10 total treatments depending on amount of improvement observed.

Treatments are done over 10-15 day block.


Medical Forms

Ready to become a new patient? Fill out this easy and secure form!

Medical Intake Form

Authorization to Release Medical Information Form

Psychiatric Referral Form

To become a patient at our clinic we will need a referral completed by your current psychiatrist and a copy of your last visit clinic notes.  This must be an MD or a DO physician.  We can NOT accept referrals from ANY other mental health care providers incl. MHNP, therapists or psychologists.
We will require that the referral be renewed on a monthly basis by your psychiatrist.
Below is a link to a blank referral form as a PDF.

Psychiatrist / Pain Specialist

If you need a psychiatrist please see the list below.

Portland Area Psychiatrists

Ketamine Treatment for Chronic Pain Syndrome

Would you like more information?

Contact us


We have chosen to err on the side of safety by using more stringent exclusion guidelines than our purposes require when deemed necessary.  We reserve the right to refuse treatment based on our clinical impression.

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