In order to be a patient at Portland Ketamine Clinic you must have a referral from a psychiatrist. We can NOT accept referrals from ANY other mental health care providers incl. MHNP, therapists or psychologists. Patients will also be required to have monthly referrals from their psychiatrist.
Below is a link to a blank referral form as a PDF.
If you need a psychiatrist please see the list below.
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
Would you like more information?