Alchemy Ketamine Assisted Therapy Waitlist
Please keep in mind that Alchemy only offers ketamine assisted therapy via prescribed lozenges, which can only be taken with one of our therapists present. We do not offer ketamine IV or IM treatments, and can only work with residents of California due to licensing laws. 

We currently only have openings for clients who can pay higher rates to subsidize those who can only afford the lowest end of our sliding scale. 

Please email irina@alchemytherapy.org if you have any questions. For more information about KAT at Alchemy, click here. 
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Demographics
Name *
Pronouns
Birthday
MM
/
DD
/
YYYY
Email
(if it's ok to email you)
Phone #
(if it's ok to call you)
Please mark any groups you identify with.
Current city of residence *
Finances
What is your current monthly income? *
Would you be able to pay a $200/hr rate for sessions, to help support the cost of someone else's sliding scale slot? (For reference, this would be about $4,600 total for a psychiatric/medical intake, 3 preparation sessions, 3 KAT sessions, and 2 integration sessions in between every KAT session) *
If you're not able to pay the $200/hr reference above, what is a more accessible financial range for you? (At $100/hr, the cost of intake, prep, integration, and 3 KAT sessions would come out to about $2,300) *
(Please note that we currently have more space for higher-paying clients and that our current sliding scale starts at $60/hr. $100/hr ends up covering the costs of our clinic, so anything over that helps subsidize the cost of people who have financial challenges.)
Ketamine Assisted Therapy Info
Are you currently seeing a therapist? *
What is the main reason you're seeking ketamine-assisted therapy?
 *
Please keep in mind that chronic pain treatments tend to be a better fit for regular ketamine infusions, a model we do not offer. KRIYA may have some referrals on their site.
Would you be interested in working with someone if they were only available to offer a maximum of 3 KAT sessions? *
I understand that if I don't have a therapist I currently see, I'll have to see an Alchemy therapist for at least 2 months of weekly preparatory sessions while continuing to assess whether or not ketamine assisted therapy is a good fit for me. 

If I do have a current therapist I've been seeing for a while, I will have at least 3 prep sessions and my Alchemy therapist will need to reach out to my current therapist to collaborate. 

I understand that connecting with a therapist at Alchemy does not guarantee access to ketamine assisted therapy, and will involve a thorough psychological and medical assessment to ensure safety and good fit.
 *
Required
Are you interested in ketamine therapy groups, where multiple people journey at the same time with a few therapist facilitators? *
Current availability for sessions (days of the week/times)? *
Any therapist preferences (background, style, identity, etc)?
Anything else we should know?
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