What Brings you to Golden Hour Wellness? *

I’m Feeling Depressed

I’m Feeling Anxious

I’m Struggling with PTSD

I have Chronic Pain

Other

How Long have you had this issue? *

0-3 Months

3-12 Months

1-3 Years

Over 3 Years

How Many Medical Providers have you seen for this? *

None

1

2 or 3

More than 3

What forms of treatment have you tried in the past? *

Prescription Medication

Holistic Alternatives

Over the Counter Medication

Therapy

Other

Which of these best describes you? *

My current treatment is working, but I’m curious about alternatives

Nothing has worked, I am desperate for a solution

My current treatment isn’t working, I’m looking for something else

I’m curious, but I am unsure if I can commit to treatment

I just want to know how much it costs

Other

Is there anything else you’d like to share with us regarding your goals?

Which of our treatments would you like to learn about? *

Ketamine Infusion for Mental Health

Ketamine Infusion for Chronic Pain

Ketamine Assisted Psychotherapy (KAP)

Please provide your information and we will reach out

We do not spam your inbox or share your information with any third party

First Name

Last Name

Email *

Phone *

Time to reach you ? *

Morning

Afternoon

Evening

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