Rebuilding Lives

With Ketamine.

Klarisana: Rebuilding Lives

Forms and Assessments

New Patients

The Intake & Consent for Treatment Form  has everything you need to get started.


Use our File Upload Form to submit a copy of your insurance card and identification to get the verification process started!

Additional Administrative Forms

If you want Klarisana to share your treatment records with outside professionals:
Release of Information – Medical Providers

If you want Klarisana to share treatment and financial information with your family & friends:
Release of Information – Family & Friends