Registration Request

Please note that your information is saved on our server as you enter it.

 

Welcome to the KTC Application Process. It is designed to be comprehensive to enable selection of participants who will grow from the training and have it inform their practices. Your responses are held in full confidence.

 

Eligible Applicants for the Training Only Professionals or those nearing licensure may apply to the Ketamine Training Center program if they hold advanced degrees, a license, or ordinations– in one of the following fields:

 

  • Physician and Psychiatrist – MDS, DOs
  • Licensed Professional Clinical Counselor –LPCC
  • Marriage and Family Therapist–LMFT
  • Licensed Clinical Social Worker (LCSW)
  • Registered Nurse– RN
  • Nurse Practitioner—FNP, NP
  • Naturopathic Doctor– ND
  • Ordained Clergy and Commissioned Chaplains
  • Physician Assistant–PA
  • Clinical and Counseling Psychologist—PhD
  • Hospice Staff with appropriate training and credentials–EX. CPE units.

At times, we accept those without these licenses because of their unique experience, interest and contributions to the field.

Confidential Personal and Medical Information It is essential that we be aware of any medical conditions, medications, supplements, life experiences or habits that can influence your experience with KTC. Our interest is in helping you have a safe and beneficial experience. Please fill out the following as completely as possible. This information is confidential.

 

Saving your work Please note that the application is a bit lengthy. If you are interrupted and would like to save your work so you can finish it at a later time, please scroll down to the bottom of the form where you will see a link next to the submit button to save and continue the form later. If you click this it will save all the work you’ve done up to that point and give you a custom link you can return to for up to 30 days. You can also request that the custom link be emailed to you once you’ve clicked on the “save and continue later” link.

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