Confidential Patient Referral Form

If you are a medical professional and you have a patient you would like to refer to the Ketamine Clinic of Hawaii, just fill out the form below and submit. We will respond to you as soon as possible. There is also a link (bottom of page) to a referral form you can download, fill out and print for increased security and confidentiality if you so choose.

Confidential Patient Referral Form

Download Confidential Patient Referral Form PDF Clicking the link will give you the ability to fill out, print and/or download the referral form.

Contact Us

    Ketamine Clinic Hours

    Monday 9:00AM – 4:30PM

    Tuesday 9:00AM – 4:30PM

    Wednesday 9:00AM – 4:30PM

    Thursday 9:00AM – 4:30PM

    Friday 9:00AM – 4:30PM

    Saturday 9:00AM – 1:00PM

    Sunday Closed

    If your suffering from chronic pain, severe depression, PTSD and your interested in Ketamine infusion treatement, give us a call or email us!

    Our Location

    Ketamine Clinic of Hawaiic
    500 Ala Moana Blvd Unit #4-470
    Honolulu, HI 96813
    Phone: 808-945-5433