Silva Wellness Pre-assessment Form

Thank you for expressing interest in our ketamine lozenge treatment. Please complete the pre-assessment form below which will enable us to establish at this early stage your initial suitability before progressing to the full psychiatric assessment with our KAP prescriber. 

Please specify which package treatment you would like to undertake: Group, 121 or Bespoke. The packages are available to view on our treatment page.

Please check your affordability for the treatment as you will be required to pay a non-refundable deposit to hold your space which will be equivalent to one weeks worth of the KAP treatment, should you be deemed suitable for the next stage of the KAP process.