Revitalist is changing the way we provide relief for treatment-resistant conditions.
Provider Referral
Request Appt.

Provider Referral

to be filled out by referring provider

Ketamine Referral Form
Spravato Referral Form
  • Ketamine Referral Form
  • Spravato Referral Form

We have updated our current in-house services to our
physician-led home ketamine therapies.

At the current time we will only be offering virtual,
at-home services.

If you would like to schedule an appointment, please visit

Schedule an Appointment

For medical record requests, please email medicalrecs@revitalist.com