Delic Announces Pending Acquisition of KWC by Peter/PetraMD - Patients Please Contact Us For More Information

Provider Referral Form

Thank you for referring your patient to Ketamine Wellness Centers. All records uploaded via the form below are kept confidential. In addition to completing this form, you may fax the patient’s medical records to our secure line: (844) 538-9355 (844-KET-WELL).

If you are looking for the Medical Records Release and Request form, you can find it here.