Please submit a Full history of medical health, including any surgeries, dental work etc. Please indicate the year any of the above took place.

Are you on any pharmaceutical drugs for any condition, including heart medications, hormone therapy, and high blood pressure SSRIs Please give us the name, the dosage and for how long you have been on these drugs

Please disclose all recreational drugs such as crack, crystal cocaine, MDMA, LSD, and Ketamine that you are currently using as well as any that you used regularly in the past along with an indication of when last you used them. Not disclosing drug use can be very dangerous. This information is kept in the strictest confidence.

Please disclose your full psychiatric history. (Depression, anxiety, schizophrenia or any other mental health issues). Please tell us if you were ever admitted for psychiatric care and if so, where, when, and for how long.

Are you currently taking any vitamins, minerals, herbs, homeopathic remedies, or any other supplements. What are they, what is the dosage, and how often do you take them? 

What vaccinations have you received during your life. Please indicate if any Covid vaccines have been received.

Do you have any experience with Plant Medicines or psychotropics? If yes, please state your previous experiences.