• Healthcare Provider TMS and Ketamine Referral Form

  • This form is exclusively for medical providers seeking a referral for their patients. This form complies with all HIPAA requirements. 

    Please complete the information below so we may prioritize your patient's care.

     

    If you are not a provider, please call 406-839-2985 or complete our contact form.

    Click here to complete. 

  •  -

  • Open House

    Please complete the information below. 


  • Patient Referral Information


  • Please click the Submit button below so we may

    get back to you in a timely manner. 

  • Should be Empty: