Ketamine Questionnaire – BodyRejuvenation

What do you know about ketamine treatment?

Do you find it difficult to concentrate?

Did you experience difficulty falling asleep or staying asleep?

Do you often feel overwhelmed or under pressure?

How long have you been suffering from anxiety or depression?

Have you received ketamine treatment before?

Do you have concerns about ketamine treatment?

Are you currently taking other medications or receiving other treatments?

Are you currently prescribed medications for depression or anxiety?

Are you interested in proactive healthcare and preventative measures to optimize your health and longevity?

Do you stay active and prioritize healthy lifestyle habits like exercise and nutrition?

Would you be open to exploring evidence-based, cutting-edge therapies for anti-aging and wellness?

Are you comfortable providing recent blood work or participating in a comprehensive health assessment?

Do you believe in a collaborative approach to healthcare, working with medical professionals to achieve your goals?

How much do you budget for your wellness each year?

In the last 3–6 months, what’s been the most frustrating part about your health, energy, or appearance? Please be as specific as possible

(numbers on the scale, lab results, clothes that don’t fit, comments from others, photos you didn’t like, etc.).

Can you describe a recent moment when this problem really bothered you or got in the way of your life? What happened, and how did it make you feel?

Enter your zip code

We need to make sure your state allows telehealth.

Name

First

Last

Email

Phone

How did you hear about us?

Please specify

If you heard about us from another source, please specify.

Our clinic is located in Hallandale, Florida, are you nearby?

If you live far, we do offer virtual consultations