FIRST NAME *
SURNAME *
DATE OF BIRTH *
SEX *
CITY *
PHONE NUMBER *
EMAIL *
DATE OF CEREMONY *
OPMERKING
WHAT IS YOUR EXPERIENCE WITH PSYCHEDELICS? *
ARE THERE ANY PHYSICAL AND / OR EMOTIONAL PARTICULARITIES THAT MAY BE IMPORTANT TO KNOW? *
ARE YOU USING MEDICATION? IF THIS IS THE CASE, PLEASE GIVE AN EXPLANATORY STATEMENT WITH THE NAME OF THE MEDICINAL PRODUCT, THE FREQUENCY OF USE AND THE DOSAGE (OBLIGATED TO MENTION ALL!) *
ARE YOU ON A DIET OR DO YOU HAVE FOOD ALLERGIES? *
WHAT IS YOUR MOTIVATION TO PARTICIPATE IN A CEREMONY? DO YOU HAVE SPECIFIC EXPECTATIONS? ARE THERE TRAMATIC EVENTS FROM YOUR PAST THAT WE NEED TO KNOW ABOUT? *
Click here to confirm that you are complying with the preparations. *
