INTAKE FORM

If you are Interested in our Services, please fill this out and we will get back to you. The more information provided, the better we can serve you. If you do not hear back from us in a week, please check your spam and email us at info@catalystinsightcollective.com

Please read before filling out the form:

  • Please keep in mind that only some of your treatment may be covered by insurance and the rest will be private pay. Are you able to pay privately? Keep in mind treatment costs can range from $2,000-$5,000 depending on the treatment plan and how many sessions are needed to reach treatment goals. 

  • Please know that you must arrange a ride for every ketamine session. You are not allowed to drive home on days of ketamine sessions. Are you able to find transportation for treatment on ketamine session days?

  • Ketamine sessions last 3 hours and we recommend not working the rest of the day. Are you able to get work off for ketamine session days if you need to?

Mental/behavioral health conditions (Please click any that you have been diagnosed with)
Are You Currently:
Physical health history: (Please click any of the following)

Thanks for applying! We’ll be in touch soon.

 

CONTACT ME

2855 Anthony Lane South Suite 140 St. Anthony, MN 55418

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