Informed consent is important for every medical intervention, and the unique nature of ketamine assisted psychotherapy (KAP) calls for a particularly thoughtful and detailed informed consent document. The following is an informed consent form developed for the author’s use in his own private practice. No representations are made concerning its adequacy or appropriateness for use by other practitioners, or in any other contexts; author, editors, and publisher disclaim liability for any use of or reliance on this document. However, as a document created by a psychiatrist with experience in KAP, this form may serve to illustrate the range of issues that an informed consent document might address.

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