Contact

Get In Touch With Us

To reserve your place on one of our signature psychedelic retreat programmes please contact us via this form.

Name

Telephone

Email Address

Message

Medical Questionnaire

Although in 95% of cases there are not contraindications when attending one of our retreats, for the safety and enhanced experience of our guests, we kindly ask all applicants to fill out a medical questionnaire. Please note that pre-existing conditions don’t automatically prevent participation. Yet, it’s essential for us to understand any factors that may contraindicate with the medical situations of our guests.

Please note: you have the option of speaking English, German, or Dutch. If you do wish to speak in either German or Dutch please respond to the questions below in your preferred language. However, keep in mind that our retreats are held primarily in English

Firstname

Lastname

Date of Birth

Gender

Email Address

Do you suffer from any physical or mental health issues? Do you suffer from any physical or mental health issues? Yes No

If yes, please define

Have you or any member of your family suffered from any mental health conditions? Have you or any member of your family suffered from any mental health conditions? Yes No

If yes, please define

Are you currently undergoing any medical or therapeutical treatments or interventions? Are you currently undergoing any medical or therapeutical treatments or interventions? Yes No

If yes, please define

Do you regularly take any medications, including for Asthma or over the counter pain medication? Do you regularly take any medications, including for Asthma or over the counter pain medication? Yes No

If yes, please define

Is there anything not covered in the above questions you feel would be relevant for us to be aware of? Is there anything not covered in the above questions you feel would be relevant for us to be aware of? Yes No

If yes, please define

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