NAMEEN PROVIDER REFERRAL

At Nameen Infusion & Wellness, our dedication lies in partnering with healthcare providers to deliver top-notch care to our patients. We have observed that combining ketamine infusions with continuous therapy and medication oversight yields effective and enduring results for individuals seeking relief. 

Should you wish to refer your patient or have any inquiries, kindly complete the referral form below or reach out to us directly via the following contact information:

SUBMIT MESSAGE

Message

NAME OF PRACTICE

Email

PROVIDER PHONE

PROVIDER NAME

EMAIL: hello@nameeninfusion.com
OFFICE: (602)598-1398

Patient name

Patient Phone

Patient Email

patient dob

Patient's Conditions and Diagnosis

Reason for Referral

TODAYS DATE

Message

Your message has been sent

Thank you for contacting us. You can expect to hear back within 24-48 hours.