Start Your Wellness Journey

Take the first toward reclaiming your life by completing the form below. A Reverie Mind team member will connect with you shortly.

INFORMED Intake Questionnaire

Patient Details

INFORMED Communication Platform

Securely share your medical history with our care team and track how effective you feel your Reverie Mind treatment plan is with INFORMED, a HIPAA-compliant communication tool.


Step 1: Confirm

Confirm your interest in signing up for INFORMED by completing our intake questionnaire.

Step 2: Click

After submitting your questionnaire, you’ll soon receive a text message from our clinic phone number, +1 (480) 269-6960.

The message will contain a hyperlink; click it!

Step 3: Complete

You’ll be asked to enter your date of birth. Complete your details and continue.

Step 4: Commence

You’re ready to begin! Follow the prompts to start your symptom assessment.

Break Free

Go beyond ketamine to find the lasting relief you deserve.

(480) 590-0092