CLINICIAN REFERRAL IV Ketamine Therapy

Thank you for your interest in IV Ketamine Infusion Therapy. In order for iFusion Wellness and Ketamine Clinic to provide you a safe and beneficial therapy we require a Clinician Referral form and Medical History form (below) to be downloaded and sent back to iFusion Wellness and Ketamine Clinic. These forms must be sent to us either by e-mail, from clinician office, to todd@ifusiondallas.com or faxed to (972) 863-7997. Once we have received these forms we will reach out to you and set up a consultation. If you have any questions please don’t hesitate to contact us at (214) 205-1145.