Home-LA KAP Partners: Clinician Application Form

Home-LA's KAP Partner program allows clinicians already trained with ketamine to integrate ketamine assisted psychotherapy into their practice working with their own clients. Home-LA provides a safe and supportive environment to your clients as well as providing support for the medical components, ketamine clearance, and in-house prescriptions. We also offer clinicians supervision and treatment planning.

If you are interested in joining Home-LA's KAP Partner program, please fill out the application below.


Email *
Name (First Last) *
Email *
Phone *
How did you hear about us? *
What is your current occupation? *
Work website link (if applicable)
Education *
Active/Current Licensure status *
What training in the ketamine/psychedelic space have you taken?  If you haven't had training, please let us know that too. *
Have you worked with ketamine before?  Please describe. *
Have you had a personal experience with ketamine (oral, IN, IM), if so, please share about your experience.
How are you hoping to integrate KAP into your practice? *
Can you show proof of malpractice coverage that includes KAP? *
In your ideal world, how does Home-LA support you and your clients? *
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