State Eligibility
Do you currently live in the state of Texas?
Yes
No
Back
Next
We apologize, currently we are only able to serve patients in the state of Texas.
Please check back in the future as we are working to expand our service area.
Back
Next
What is your age?
<18
18-29
30-39
40-49
50-59
60-69
70+
Back
Next
Unfortunately we are unable to provide treatment to anyone under the age of 18.
Please consider reaching out once you are 18 and are eligible for treatment.
Back
Next
Are you currently pregnant or planning on conceiving in the near future?
Yes
No
Back
Next
There is conflicting information regarding the safety of ketamine therapy during pregnancy.
Therefore we cannon offer it in full confidence at this time for those who are pregnant or plan to become pregnant soon.
Back
Next
Are you currently prescribed Ketamine or Esketamine?
Yes, from another telemedicine provider
Yes, from a local IV clinic
No
Back
Next
It is illegal to be prescribed multiple sources of ketamine at once.
If you are considering transferring your care to Delta Wellness Collective, we will need medical records from your previous provider.
I would like to stay with my current provider
I wish to switch to Delta Wellness Collective
I acknowledge that I will require up to date medical records from my previous provider
Back
Next
Please reach out to us in order to transfer care once treatment with your current provider has finished.
Back
Next
Do you have any of the following medical conditions?
None
Uncontrolled high blood pressure despite taking medications
Severe heart problems (recent heart attack or heart failure)
Seizures or epilepsy/on medications to treat both conditions
Brain bleeding
Anuerysm/abnormal blood vessel formation
Allergy to polyethylene glycol
Ketamine Allergy
Back
Next
We’re sorry, but we don’t believe this treatment is safe for you.
Ketamine is not recommended for individuals with uncontrolled high blood pressure, as it can raise blood pressure further and increase the risk of serious cardiovascular complications. Once your blood pressure is well-managed, we encourage you to reach out so we can reassess your eligibility for treatment.
Ketamine is not recommended for individuals who have severe cardiac conditions as it can increase the risk of complications.
Ketamine is not recommended for individuals with epilepsy, as it may lower the seizure threshold, raising the risk of seizures and potentially triggering epileptic episodes. It is also not advised for those taking seizure medications.
Ketamine can raise both blood pressure and intracranial pressure. For individuals with cerebral hemorrhage or brain bleeding, any increase in intracranial pressure may worsen the bleeding or negatively impact the clinical outcome.
Ketamine can increase the risks associated with aneurysms and vascular malformations, possibly causing ruptures and bleeding.
If you are allergic to polyethylene glycol (PEG), this treatment is not safe for you, as our medication contains it.
If you have an allergy to ketamine, this treatment is not safe for you.
We hope you find a treatment that works well for you.
Back
Next
Do any of these situations apply to you?
None
I am or have been addicted to a substance other than alcohol, nicotine, or cannabis, (i.e. methamphetamines, opiates, cocaine) within the past 2 years.
I am currently prescribed and take any of the following medications: belbuca, buprenorphine/naloxone, methadone, suboxone, subutex.
I have a history of bipolar disorder 1
I have an active diagnosis of psychosis, manic symptoms, or history of psychosis, schizophrenia, or schizoaffective disorder.
Back
Next
We’re sorry, but we don’t believe this treatment is safe for you.
A current or recent history of substance abuse predisposes individuals to a higher risk to ketamine abuse.
Ketamine may not be safe for individuals currently taking methadone, Suboxone, Subutex, buprenorphine/naloxone, or Belbuca, as these medications can interact with ketamine and increase the risk of respiratory complications. If you have been off these medications for at least three months, we encourage you to contact us to reassess your eligibility for treatment.
Ketamine is not safe for individuals with a history of bipolar disorder 1 because it can exacerbate psychosis.
Ketamine may pose risks for individuals with a history of psychosis, as it can potentially trigger recurrent episodes or exacerbate symptoms.
We hope you find a treatment that works well for you.
Back
Next
Do you currently take or have taken any antidepressant or anti-anxiety medications?
Yes
No
Back
Next
Are you currently experiencing any suicidal thoughts?
Yes
No
Back
Next
Within the past three months, have you had any thoughts about committing suicide?
Yes
No
Back
Next
Are you currently experiencing suicidal thoughts along with a specific plan or method?
Yes
No
Back
Next
In the past three months, have you had any intention to act on suicidal thoughts?
Yes
No
Back
Next
Have you been hospitalized in a psychiatric unit within the past year?
Yes
No
Back
Next
Thank you for your response. Based on your answers, we believe you would benefit from a higher level of support than what we can safely offer through telemedicine.
We recommend seeking in-person support from a qualified mental health professional. Help is available—please consider reaching out today by calling or texting 988 for immediate assistance.
We wish you the best of health.
Back
Next
Looks like we may be a good fit.
To take the next steps, please schedule an appointment for an evaluation with one our medical providers.
During this meeting, we will determine if you are a good candidate for ketamine therapy and create an individualized treatment plan to help you reach your goals.
Back
Next
Appointment
Should be Empty: