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.