Schedule Your Free Consultation

Contact Us: 563-214-1594

contact@quadcitiesketamine.com

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ARE YOU TIRED OF SUFFERING WITH

DEPRESSION DAY IN AND DAY OUT?

Who are you filling this form out for?

Myself

My Spouse

My Child

My Parent

Other

How long have you been suffering from depression?

1 - 6 months

6 - 12 months

1 - 2 years

2 - 5 years

more than 5 years

How did you hear about Quad Cities Ketamine Clinic's Ketamine Infusion Therapy?

Facebook/Instagram

Commercial/TV

Friend/Family

Doctor/Counselor

Search Engine/Google

Have you ever been diagnosed with major depression, bipolar, anxiety, PTSD, or OCD?

Yes

No

How many antidepressant medications have you tried?

None

1

2

3

More than 3

Have you ever been diagnoses with schizophrenia or psychosis?

Yes

No

Do you have any of the following? 1) glaucoma, 2) history of seizures, 3) recent head injury, 4) recent heart attack/stents, or 5) uncontrolled high blood pressure? *

Yes

No

Are you now or have you been in counseling?

No, I have never tried it.

Yes, I am currently undergoing counseling

Yes, I have tried it but longer go/didn't work for me.

Please tell us about yourself

Male

Female

Transgender

How old are you?

14-17

18-24

25-49

49-64

65+

How soon are you looking to take care of your depression?

Right Now!!!

As Soon As Possible

This Week

The Month

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<<<Complete The 30 Second Quiz

Find out if you are a candidate for Ketamine Infusion Treatment

Limited Program Availability...

Depression Relief IS Possible!

That’s why we want you to take part in our Simple Quiz to REINVENT THE WAY YOU THINK ABOUT DEPRESSION. We want to share our own knowledge accumulated from study and experience and will be glad to hear any questions you have for us.

Take our 30-Seconds Quiz

See if you are qualify for a cutting edge treatment option.

Quad Cities Ketamine Clinic in Davenport, Iowa, Tara Kinney, CRNA and Jaclyn Brandmeyer, CNP lead a team of sedation and IV infusion trained and experienced staff . The team provides expert ketamine and holistic vitamin and ozone/UBI infusion therapy in a calm, spa-like environment.

They offer ketamine infusion therapy to treat depression, anxiety, post-traumatic stress disorder (PTSD), and chronic pain conditions like fibromyalgia and CRPS. The team provides comprehensive lab analysis, education, high quality supplement, and treatment packages that to get to the root cause of your chronic conditions to help you fight the problem at its source and be able to get back to high quality, functional living.

Quad Cities Ketamine Clinic

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