Sign up - Psychedelic Therapy

To register

Sign up for supervised psychedelic therapy here.

First name

Surname

Age

Residence

E-mail

Phone number

Target

Medication

Drug use today

Drug use past

Mental disorders

Suicidality/psychosis

I am struggling with suicidal thoughts I had a psychosis

Physical disorders

Additional info

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Neurotransmitter test

Select the check boxes that apply to you currently:

Psychedelic therapy

To register

To register

Neurotransmitter test

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