Patient Forms

Please fill out the form that corresponds to your particular condition. You may fill out more than one form if appropriate.  The form(s) is used to help us ensure that you are a good candidate for Ketamine treatment. The forms are also available for download in PDF format and can be submitted to Serenity Ketamine via fax or you can bring the form(s) with you with your initial consultation. We ensure your confidentiality with us.


demographics & conditions


patient health care questionnaire

Biote Symptoms (Female)

biote symptoms sheet for females

Biote Symptoms (Male)

biote symptoms sheet for males