FOR REFERRING PHYSICIANS

Is Psychedelic-Assisted Therapy Right for Your Patient?

Bloom Institute offers physician-supervised, psychiatrist-guided psychedelic-assisted therapy for adults with treatment-resistant mental health conditions. Initial intake assessments are covered by Alberta Health Services.

PAT Clinician Referral Form

Download, complete, and fax to (403) 948-3353.

Incomplete referral forms will not be accepted and will be returned to sender.
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Appropriate if the patient:

  • Has MDD/PDD, PTSD/CPTSD, GAD, OCD, or Bipolar II (depressive phase)
  • Has not responded to at least two evidence-based treatments
  • Is 18+ and under physician or psychiatrist care
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Not appropriate if:

  • Active psychosis, mania, or schizophrenia
  • Pregnancy, breastfeeding, or planning pregnancy within 12 weeks
  • Uncontrolled hypertension or acute cardiovascular disease
  • Active severe substance use disorder
  • Neurocognitive disorders or dementia
  • Previous negative response to psychedelic-assisted therapy

Required Labs (within 90 days)

CBC, electrolytes, Cr, Ca, Mg, Phos, Albumin, Ferritin, Vitamin B12, TSH, AST, ALT, GGT, Bilirubin Total and Conjugated/Direct, Urinalysis. Drug levels if relevant. Pregnancy test if relevant. HbA1c and lipids if on an antipsychotic. ECG if indicated.

Bone Health Clinic

Dr. Eric Campbell (Internal Medicine) is accepting referrals from physicians and nurse practitioners. AHS-covered service. A referral letter with patient information and relevant investigations is sufficient.

Helpful investigations prior to referral:

Osteoporosis: BMD (if available), lateral T/L spine X-ray, CBC, creatinine, calcium, albumin, phosphate, PTH, TSH, SPEP, 25-OH vitamin D, fasting serum CTX, celiac screen (if indicated)
Osteoarthritis: X-ray of affected joint(s)
Referrals can be faxed directly to Bloom Institute of Mental Health & Wellness: (403) 948-3353