Referral

Referral Portal

Refer your patients directly to blūvera clinic for IV ketamine infusion therapy consideration. We will contact your patient within 24 hours.

HIPAA-conscious workflow: please avoid sensitive attachments unless necessary. You may also fax referrals.

We generally reach out to referred patients within one business day.

Referring Clinician

Name*

Practice / Facility*

Phone*

Fax

Email*

Patient Information

Full Name*

Date of Birth*

Patient Phone*

Patient Email

Reason for Referral*

Clinical Summary / Notes (optional)

Upload Clinical Notes (optional)

Please avoid insurance cards; they’re not required.

I confirm the patient has consented to be contacted by blūvera clinic.

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