Group Retreat Form - Sophrodelic

Psilocybin Group Retreat Application Form

Whether you need you need clarity in your life or would like to begin healing past traumas or other psychological issues in your life, Sophrodelic is specifically focused on providing tailor-made retreats which ensures the utmost care and support for you.

First Name

Last Name

Gender

Date of Birth

Phone Number

Profession / Occupation

Address line 1

Address line 2

City

Country

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Email

Emergency Contact Country of Residence

Emergency Contact - Relation

Have you used psychedelics before?

Have you explored other means for achieving an expanded state of consciousness?

Are you currently in therapy and/or a part of any support groups?

Do you have any concerns or questions about participating in the activities Sophrodelic offers?

What are your food preferences?

Dietary Needs & Allergies

How did you hear about us?

Preferred time period for Retreat

Secondary choice time period for Retreat

Psilocybin Group Retreat Application Form​

Psilocybin Group Retreat Application Form