Ketamine therapy treatments offer relief for many patients and may provide relief for you. We recognize that choosing to move forward with these treatments can be challenging and requires a significant commitment. We look forward to working with you as partners in your care. Please contact us at any time with questions, comments, or for more information.

Sincerely,
Dr. Amy van Elkan
mail@crestlinehealthandwellness.com
205-848-2768

New Patient Registration

To register as a new patient, please complete and submit the forms in this packet:

• General Information – 2 pages
• Medical History – 2 pages
• Consents and Authorizations – 2 pages
• General Policies – 2 pages
• Notice of Privacy Practices – 3 pages
• Physician Referral – 1 page

If you are being treated for a mood disorder, our minimum requirement is that patients have, and list in their paperwork, a psychiatric professional who they can rely upon for their psychiatric needs.

Submitting Your Forms

You may submit the completed forms by mail or bring them with you to your consultation.

Mail:
Crestline Health and Wellness
Shades Brook Office Building
3300 Cahaba Road, Suite 100
Birmingham, Alabama 35223

Email:
mail@crestlinehealthandwellness.com
Fax: 205-941-8055

Scheduling Your Treatment

Contact us at any time to schedule your treatments.