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6565 West Loop South 530, Bellaire, TX 77401, US

Call: 832-436-4055

Provider Referral

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Ketamine infusions, dTMS and Spravato are especially effective for treatment of refractory depression. If you have a patient that you believe would be a good candidate for any of our treatment options please submit the referral information below and a member of our staff will reach out to you as well as your patient.

Provider Referral Form

Provider Referral Form for Ketamine Infusion Therapy

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Patients Name*

First Last

Patients DOB*

Please list conditions & diagnosis*

Current Medications

Allergies

Special Considerations

Date of recent Labs Ordered

With a special interest in treatment-resistant disorders, Dr. Sandhya Prashad works closely with each patient, taking the time to understand their overall health and well-being so she can develop a truly customized treatment plan.

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