Mental or Medical Health Professional Referral

Do you have a patient or client who may benefit from ketamine treatment? Please fill out and email the pdf below, email info@ketamendofmi.com, or fill out the referral information below. We look forward to partnering with you and your patient!

Provider Referral for Ketamine Injection Treatment (pdf)Download

Refer a patient

Referral for health professionals (confidential)

Name of health professional

Email of health professional*

Name of person being referred

Patient contact information (phone number and/or email)

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Ketamend of Michigan, PLLC

36400 Woodward Avenue, Bloomfield Hills, Michigan 48304, United States

248-617-6755

Hours

Mon	09:00 am – 05:00 pm
Tue	09:00 am – 05:00 pm
Wed	09:00 am – 05:00 pm
Thu	09:00 am – 05:00 pm
Fri	09:00 am – 05:00 pm
Sat	Closed
Sun	Closed

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