First Name *

Last Name *

Email (please check your spam folder to verify and mark us as no spam) *

Phone Number *

Birthday *

It’s so nice to get to know you a little bit. Can you tell us briefly about yourself. Where do you live and what do you love? *

I confirm that all the information I have provided in this application is true, accurate, and given to the best of my knowledge and honesty.

Which group retreat are you interested in? If you are interested in a private retreat, please go to our private retreat page. *

Is this going to be your first psychedelic experience? *

Yes

What is your intention for this experience? What shift in your life would you like to experience? *

Please tell us about any past or present mental health conditions (including depression, anxiety and PTSD). If you feel comfortable, please share any significant traumas or difficult experiences from both your childhood and adulthood. If you prefer to discuss this in person, that's perfectly fine — please just let us know the intensity of your past traumas. *

Do you have experience with related practices (including therapy, meditation, breath work, sound healing, dance, yoga, etc)? *

What is your family history of mental illness? *

Do you have any chronic or severe health issues? Do you have a current substance addiction? *

We understand this can be a sensitive topic, but it is important for us to know: Have you experienced suicidal thoughts or tendencies? If so, how often and how recently? Have you ever had a suicide attempt, and if so, when did this occur? *

Do you have high or low blood pressure? *

Can you let us know how high? *

Have you been diagnosed with Schizophrenia, Bi-Polar Disorder, Borderline Personality, or Psychosis? *

Yes

Can you share more details about your diagnosis please? *

Are you taking medications? If yes, please provide the name, dosage, frequency of use,as well as details of the condition that is being treated. Please check our list of medications that interact with psilocybin and if your medication is on it, please let us know if you are willing to come off. *

Our pricing starting at 4600 Euros for a 6 day retreat reflects our proven track record of facilitating profound internal shifts in our clients' lives, which stems from our expertise and the effectiveness of our Inner Shift method. Are you ready to invest in this experience to let go of old ways of thinking and discover new ways of living? *

Are you interested in a private (6,200 Euro) or a shared double room (4,600 Euro)? *

Will you pay in full for our exclusive psychedelic experience or do you prefer a payment plan? *

Are you interested in making your experience even more impactful by booking extra preparation and integration sessions? *

Do you have a Referral/Promotional Code code?

How did you hear about us? *

I want to learn more and stay informed about psychedelic therapy and other tools that bring resolution and peace to my inner battles.

I agree to terms and conditions and privacy policy provided by the company. By providing my email and phone number, I agree to receive text messages from the business.