Alalaho Intake Form 💛 Full Circle Fund

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In support of your process

This form is designed to help explore whether a psychedelic journey with us is the right decision for you at this point in your life. If you choose to attend a retreat with us, then it will also provide us with information that will help us support your individual process in the best possible way.

Psychedelics & risks

Psychedelics can be powerful tools for inner exploration but they also come with risks. While there are preliminary studies on psychedelic assisted psychotherapy showing promising results, there are also cases of symptoms worsening after a psychedelic experience. Alalaho does not provide therapeutic or clinical support and can only safely hold space for participants in good mental and physical health.

Contraindications

The main reasons for not being able to participate in our retreats include serious cardiovascular (e.g. recent stroke or heart attack) or neurological issues (e.g. epilepsy or brain trauma), use of antidepressant (e.g. SSRI/TCA), mood stabilising (e.g. lithium) or antipsychotic (e.g. Abilify) medications and severe mental health problems (e.g. psychosis, bipolar disorder, personality disorder These conditions and medications pose additional risks, do not combine well with psilocybin containing truffles and may produce potentially dangerous situations that we are not equipped to safely manage in a group retreat setting. It is therefore in your interest to answer the following questions truthfully and thoroughly.

Begin the journey

Depending on your particular circumstances, this questionnaire could take around fifteen to thirty minutes to complete. We recommend carving out some time and setting up a comfortable and supportive environment while you fill out this form. By reflecting on and responding to these questions, you may begin to get a sense of where you are now in your life, whether a retreat is right for you at this time, and how you might begin to orient yourself towards the experience. Allow for this be a constructive step in your journey.

Confidentiality first and foremost

We take confidentiality seriously. The information you provide to us will only ever be shared with relevant members of the retreats team and never with anyone outside of the organisation. The content of your questionnaire will be stored in a database accessible only by select members of the Alalaho team. Your data is held only to evaluate your suitability for the retreats programme and to understand your individual needs. Your data is not passed on to anyone outside of the organisation. You can read more about our privacy policy and data protection at www.alalaho.org/privacy-policy.

*Unfortunately, we cannot accept any applicants with the above conditions and medications in questions 8 & 9, as these pose additional risks and may produce situations that we are not equipped to safely manage in a group retreat setting.

Personal responsibility statement
I will be taking psilocybin-containing truffles of my own volition. I acknowledge that no substance is entirely risk-free and that I am familiar and comfortable with the risks of psilocybin truffles. I have done my own independent due diligence with respect to the safety of psilocybin truffles, including but not limited to drug and medicine interactions, genetic and biological predispositions, and psychological contraindications.

Outcome disclaimer
I understand that Alalaho cannot guarantee the outcome of my psychedelic or overall retreat experience. I also acknowledge that the Alalaho facilitators are not doing this work as licensed medical or mental health professionals and that the services offered by Alalaho are not a substitute for psychotherapeutic or medical treatment or advice.

Liability Waiver
I understand that all activities that are undertaken at the retreat, including but not limited to the psychedelic ceremony, bodywork, group interactions, and nature connection, carry some inherent risk, and I expressly assume all risk for any damage to self or property. Should I require emergency medical treatment as a result of an accident or illness during my attendance and participation in the retreat, I agree to be financially responsible for any medical or legal expenses that may be incurred as a result of such medical treatment.

Code of conduct
For the benefit and support of all retreat participants and facilitators, I agree to participate in the retreat for its full duration and to remain open to exploring my experience. I agree that facilitators of Alalaho have full discretion to remove me from the retreat if I fail to comply with any ethical or safety guidelines, including but not limited to, the use of other psychoactive materials, dishonesty, harassment, or causing psychological or physical danger to the staff or other participants.