Consultation

Fill out this form to schedule your free telephone consultation.

Once this initial form is completed, you will receive an email with a patient intake form from our secure portal, Osmind. When you’ve submitted the intake paperwork, our clinic manager will contact you to schedule your consultation with the doctor. Please feel free to contact our office at 805-321-8471 with any questions.

FIRST NAME * LAST NAME *EMAIL ADDRESS * PHONE *WHAT CONDITION ARE YOU SEEKING TREATMENT FOR? *HOW DID YOU LEARN ABOUT US? *IF YOU WERE REFERRED TO US, PLEASE LET US KNOW WHO SENT YOUWHY ARE YOU INTERESTED IN KETAMINE THERAPY AT THIS TIME? WHAT QUESTIONS DO YOU HAVE? PLEASE INCLUDE ANY ADDITIONAL INFORMATION YOU WOULD LIKE TO SHARE WITH THE DOCTOR. *

Thank you! Your submission has been successfully received.

Please expect a call from us soon to schedule a phone consultation with Dr. Rivas and discuss the next steps in your care.

Before your consultation, kindly complete your patient intake form. Look out for an email from Osmind, our secure patient portal, which will include a direct link to the form. You should receive this email within 24 hours.

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