Professional Referrals

If you are a provider who feels this work may support your client, you’re welcome to share their information below.
Our referral process is simple and grounded — no clinical notes or diagnostic details are required. We only ask for basic contact information so we can reach out with clarity, consent, and respect for the client’s process.

This pathway is available for therapists, guides, medical professionals, and other healing practitioners who believe their client may benefit from nervous system support, functional nutrition, somatic work, or psychedelic preparation and integration.

Please include only the information needed for us to make contact.
We honor privacy, autonomy, and confidentiality in every part of the process.

Your First Name *

Your Last Name *

Your Practice Name

Your Relationship to Client *

Phone *

Email *

Clients Full Name *

Client's Email *

Client's Phone Number *

Client's Preferred Contact Method *

Supportive Pathways (check all that apply)

Body Work (Somatic / Embodiment)

Energy Work (Reiki, Chakra Balancing Intuitive Support)

Functional Nutrition

Ketamine Assisted Sessions (On-site with RN Supervision)

Mind Work (Mindfulness, Breathwork, Meditation)

Psychedelic Preparation/Integration, Psilocybin

Other _______________________________________________________

By submitting this referral, you acknowledge and agree to the following:

This form is only for sharing basic contact information for a client.
Do not submit clinical notes, diagnostic information, treatment plans, or medical history.
Creative Fire Alchemy provides supportive, somatic, nutritional, and integrative services, including RN-supervised ketamine-assisted sessions. We do not diagnose or prescribe.
You confirm you have the client’s permission to share their contact information.
This referral initiates contact only; participation in services requires direct conversation with the client.
Creative Fire Alchemy does not provide emergency or crisis services.
Information submitted is kept confidential and will not be shared with third parties.

I agree to the Terms & Conditions for submitting a provider referral.

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