Application Form

Please take the time to fill out the application as honestly and accurately as you can. This information helps us to assess your suitability for the retreat on a basic safety level, and to prepare and accommodate for you and the other guests on retreat. Once you have submitted your application, we will contact you to schedule a call with one of our team.

All the information you provide on the form will be kept strictly confidential.

Apply
Your Gender
Including but not limited to; anti-depressants, SSRIs, blood pressure medications, mood stabilizers, benzodiazepines or other anti-anxiety medications, pain management, or opioid replacement therapies.
Preferred programme *
When would you like to have your session? *
I certify that all information provided on this form is true, complete and accurate. I understand that acceptance for a private session is based, in part, on the information provided on this form. I understand that the information provided must be truthful and accurate to ensure the safety of myself and other retreat participants, and that falsifying or misrepresenting this information could endanger myself or others. I understand that private psychedelic sessions are not intended as a substitute for medical or psychotherapeutic care. *