Spravato Forms

These links should direct you to forms you may need if you are applying for esketamine (Spravato) treatment through our office.  Please complete these forms if directed by our office staff, and then submit them to us.  Forms may be submitted through the document upload feature below or on our forms page

PHQ-9 Form

Complete form online then add total combined score.

Spravato REMS Form

Complete page 2 only and then submit to our office.

Spravato Benefits Investigation Form

Complete pages 3-6 only and then submit to our office.

Document Upload

Upload files here