Elevated Healers Screening Form
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Elevated Healers is a Ketamine-Assisted Psychotherapy (KAP) group created intentionally for those working in the human services field who want to deepen their personal healing work, explore their role as healers, combat burnout and compassion fatigue, and foster connection and community. We define "Healers" as those who work with the physical, mental, spiritual and/or energetic bodies to promote health, wellness and connection. They may include, but are not limited to: first responders, nurses, physicians, therapists, bodyworkers, etc.

Which of the healing professions do you practice? 
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Did you attend one of our info sessions to learn more about KAP?
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Contraindications
Ketamine is contraindicated for the health conditions listed below. If any of these apply to you, ketamine is not a safe treatment option for you.
  • Primary Psychotic or dissociative disorder
  • Hypomania or mania
  • Unstable angina (chest pain/heart disease)
  • Uncontrolled hyperthyroidism
  • Uncontrolled hypertension
  • Increased intracranial pressure
  • Evidence of liver disease
  • A previously demonstrated allergy to ketamine
  • Pregnancy
In addition, ketamine cannot be mixed with opiates. If you are taking anxiety medications such as benzodiazepines, pregabalin, or gabapentin, they may blunt the antidepressant effects of ketamine. We ask that you refrain from taking various medications and alcohol 48 hours before and after your medicine session. if this is problematic for you, please let us know, as this could preclude you from attending the group.

Those with a history of cystitis or other bladder issues may need to be cleared by urological consultation, due to the rare but potentially significant adverse effect of cystitis.
Have you been diagnosed with or treated for any of the above contraindications? *
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