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Ketamine Screening

Terms and Conditions:

By submitting a Ketamine Therapy screening form to Alevea Mental Health, you agree to the following terms and conditions:

  1. Accuracy of Information: You certify that the information provided in the screening form is true, accurate, and complete to the best of your knowledge.

  2. Contact Information: You authorize Alevea Mental Health to contact you via phone, email, or text message to follow up on your screening form and provide you with information regarding our services.

  3. Consent to Treatment: You acknowledge that submitting a screening form does not create a patient-provider relationship with Alevea Mental Health and that any services provided will require a separate agreement and consent to treatment.

  4. Privacy Policy: Your personal information will be handled in accordance with our Privacy Policy.

  5. No Guarantee: You acknowledge that submitting a screening form does not guarantee that you will be eligible for or receive Ketamine Therapy.

  6. Age Requirement: You certify that you are at least 18 years old to submit a screening form.

If you have any questions regarding these terms and conditions or the screening form, please contact us at 480-923-6200.

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