Pittsburgh Ketamine Patient Information

Helpful Forms and Documents

These forms are provided for your convenience. All forms are also available to be completed upon your visit to Pittsburgh Ketamine. It may, however, streamline your visit and/or yield better results to complete these forms in the comfort of your home, and simply submit them to the doctor upon your arrival.

For your personal privacy, we provide these documents as downloadable pdfs rather than online forms. Please print and complete the documents and bring them with you when you visit Pittsburgh Ketamine.

 

Mental Health Intake Form (required)

This is a general questionnaire which helps us to provide you with the best service, and to ensure the most successful results possible.

You can download the file here. Please fill out entire form and back to the doctor.

Beck Depression Inventory (required)

The Beck Depression Inventory is a questionnaire used as a diagnostic tool for patients with mood disorders to measure the severity of depressive episodes. Dr. Macler uses this questionnaire in conjunction with personal interviews to determine the treatment protocol best suited for each patient.

You can download the file here. Please see the instructions at the bottom of page 3 to submit results back to the doctor.

Montgomery–Åsberg Depression Rating Scale (optional)

The Montgomery–Åsberg Depression Rating Scale (MADRS) is an alternative  diagnostic tool for patients. Dr. Macler generally prefers the use of the Beck Inventory (available above), but this form is made available for cases in which it might be preferable.

You can download the file here. Please see the instructions at the bottom of page 2 to submit results back to the doctor.

More Information

For unbiased information on the use of Ketamine for treatment-resistant depression, see this paper as well as our Press Page, which contains links to a wide variety of resources on the topic.