Braxia Health Self Referral Form
Completing this form does not guarantee access to treatment. This form authorizes Braxia Health to contact your community physician on your behalf for a referral. When your community physician completes the referral it will be assessed for eligibility. If eligible, you will be booked in with a member of our physician team for a more in depth referral whereby it will be decided if you are a suitable candidate for ketamine treatment.