Choose Ketamine Survey- Webflow Funnel

Psychedelic Therapy Check-In

A few questions to get to know your unique circumstances and find out if ketamine therapy is right for you.

What are you interested in improving with ketamine therapy?*

Anxiety LevelsPTSDDepressionMood DisordersSubstance AbuseOther
Please describe:

Ketamine Therapy
can help

Ketamine assisted therapy is a breakthrough treatmenthelping individuals facing Chronic Stress, Anxiety, Depression, Post Traumatic Stress Disorder, and Mood Disorders.

Lately, have you been struggling with any of the following?*

😕 Lack of motivation😰 Excessive worrying🤯 Poor focus😠 Excessive negative self-talkNone of these

Results you can trust

After completing our program, over 90% of our clients report an improvement.

"We are so confident that if you are not 100% satisfied at any stage of the process we will refund you the full cost of the program."

Stephanie Lyn Coleman MD, MPH
Lead Medical Advisor

Are you located in Colorado, Nevada, Washington State, New Mexico, Iowa or Minnesota?*

YesNo
Where are you located?

Do any of the following apply to you?*

Under 18 years oldBiological female who is pregnant, nursing, or trying to become pregnantPrimary psychotic disorder (e.g. schizophrenia, schizoaffective disorder)Family history of psychotic disorder (e.g. schizophrenia, etc)Prepared for or attempted to end your life (in the past year)Method, intent, or plan to commit suicide (in the past month)Diagnosed with a personality or mood disorder (e.g. bi-polar etc)None of the above apply to me

How much do you think the average ketamine treatment costs?*

$500$1000$2000I'm not sure

Choose Ketamine Reviews

A collection of reviews and experiences from real Choose Ketamine Patients.

Your journey is supported by our certified guides who are trained in psychedelic support including preparation and integration.
Do you prefer your guide to be...*

💛 Spiritual🧠 Clinical📋 AnalyticalI'm not sure