Private Psilocybin Session

Private Psilocybin Session Application Form

Please fill out the following form with the required details. You will be contacted directly by Bénédicte to schedule the initial pre-session meeting, before finalizing a date for your private session.

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?

How did you hear about us?

Private Psilocybin Session Application Form​

Private Psilocybin Session Application Form