Healthcare Providers

Please use this form to refer a patient that may be a good candidate for one of Be the Change's Ketamine and TMS Treament Programs.

 
 
 
 









 
 
 
 
 
 

Please type in the word CONFIRM above, to confirm that, to the best of your professional assessment/knowledge, the above referred individual does not have psychosis or psychotic features, Bipolar I, or current Methamphetamine abuse.