Fluorescent fruit

Retreat Application Form

In order to apply for the retreat, please fill in the form below. All information provided is kept confidentially and we rely on your honesty and accuracy to help us better evaluate whether our psychedelic retreats are a good option for you.

Application form
Name & Surname
Name & Surname
First
Last
Are you currently taking any of these medications?
Have you experienced any of the following conditions?
Are you currently pregnant or breastfeeding? Are you planning to have a child soon?
Have you or anyone in your close family (parents or siblings) been diagnosed with or suspected of having any of the following conditions?
By submitting this form you consent that your information is processed according to data protection regulation.

Be the first to know!