Patient Portal

Welcome to the patient portal. On this page, you will find all the forms that we require prior to starting your journey to health and wellness. Please fill out all the forms listed below prior to your office visit.

  1. Payment can be added going to Pricing and Payments
  2. Please fill out all the forms and policies prior to your office visit

Acknowledgement of Payment & Cancellation

Consent to Electronic Communication

Informed Consent to Ketamine Treatment

Medical Release

Pregnancy Waiver

Privacy Policy

Medical History

Waiver of Liability

Patient Health Questionnaire

Acknowledgement of Ongoing Care

Virginia Infusion Therapies

The First Ketamine Clinic in Northern Virginia

Virginia Infusion Therapies is one of the the first Ketamine Clinics in Northern Virginia, and the first clinic in Loudoun County to provide Ketamine infusion therapy for the treatment of Major Depression and Pain Conditions.  The clinic was established by four physicians in Loudoun who, through their professional experiences in medicine and their personal family experiences with depression, recognized that there are major problems in the recognition and treatment of depression.  They recognized that Major Depression, Post-Traumatic Stress Syndrome, and some pain conditions are often medical emergencies that requires treatments that are more effective…  and more effective IMMEDIATELY.  

Are you ready to schedule your free consultation?

Request your free 15 minute phone consultation and speak with a clinician about ketamine infusions and how we can help you live your happiest, healthiest life.