Choose Ketamine Survey

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Hi, what is your name?* This field is required.
First Name
Last Name
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Nice to meet you {FirstName}, what's your email?* This field is required.
example@example.com
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What are you interested in improving with the Choose Ketamine service?* This field is required.
Anxiety Levels
PTSD
Depression
Mood Disorders
Stress
Other
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Choose Ketamine's clinician prescribed online ketamine therapy programs provide an effective alternative to traditional therapies and medications.

Ketamine assisted therapy is a breakthrough treatment helping individuals facing:

Chronic Stress

Anxiety

Depression

Post Traumatic Stress Disorder

Mood Disorders

Whether you feel stressed, lost, or anxious Choose Ketamine is here to help!
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Lately, have you been struggling with any of the following?* This field is required.
Lack of motivation
Excessive worrying
Poor focus
Excessive negative self-talk
None of these
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Thank you for sharing!

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.

Dr. Stephanie Coleman, MD. Choose Ketamine Medical Advisor
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Are you located in Colorado, California, Texas, Florida, Ohio, Michigan, Georgia, Washington State, New Mexico, Iowa, or Minnesota?* This field is required.Choose Ketamine services are available in these states.
Yes
No
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Where are you located?* This field is required.
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Do any of the following apply to you?* This field is required.Choose Ketamine isn't a fit for certain people or conditions. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1-800-273-8255, call 911, or go to the nearest emergency room. Responses are not monitored in real-time by Choose Ketamine.
Under 18 years old
Biological female who is pregnant, nursing, or trying to become pregnant
Primary psychotic disorder (e.g. schizophrenia, psychosis)
Family history of psychotic disorder (e.g. schizophrenia, psychosis etc)
Prepared for or attempted to end your life (in the past 6 months)
Method, intent, or plan to commit suicide (in the past month)
Diagnosed with Type I (one) Bi-Polar
Actively struggling with substance abuse (4+ Alcohol Drinks Per Day etc.)
Uncontrolled hyperthyroidism
Uncontrolled hypertension
None of the above apply to me
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How much do you think the average ketamine treatment costs?* This field is required.
$500
$1000
$2000
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Ketamine sessions can cost vary from $500 - $2,000 per session, and most ketamine clinics do not provide integration programs alongside treatment.

Choose Ketamine's at-home ketamine therapy program can be as low as $158 per session, all while enjoying the comfort and safety of being in your own home.

And, the even better news is that we accept Health Savings Account (HSA) payments and offer payment plans with KLARNA
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Other FAQ's about the Choose Ketamine program;

What is the difference between oral ketamine and IV?

Each type of ketamine is administered in a different way, which affects the convenience, effectiveness and cost. IV is typically infused into a vein from a bag that drips the substance in. Oral ketamine, also known as sublingual ketamine, is dissolved in the mouth in a tablet form. The most cost-effective option is oral ketamine.

How many sessions are usually recommended or prescribed?

Choose Ketamine offers 2, 4 and 6 session packages. You can discuss the most appropriate package with the prescribing physician during your consultation.

Is it possible to take Ketamine while taking other medication?

Most medications do not counter-interact with Ketamine, however, you can discuss any specific medications you may be on with the physician during your consultation.

What is the dosage?

The dosing is based on your weight and factors such as your experience with psychedelics are taken into consideration by the physician.
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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...* This field is required.
Spiritual
Clinical
Analytical
I'm not sure
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What is your preferred contact method?* This field is required.
Email
Text Message
Phone Call
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What is your phone number?
Please enter a valid phone number.
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Do you have any questions for us?
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Ok
Ok
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