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  • Reserve Your Personal Consultation

    Discuss your psilocybin options with one of our experienced staff on a 25 minute call. Please complete this brief application to book your free consultation.
  • Preferred Pronouns*
  • Format: (000) 000-0000.
  • Date of Birth (must be 21 or older)*
     - -

  • Experience Questionnaire

    Please take a moment to answer these questions about your reasons for exploring psychedelics. Your answers will allow our staff to better assist you during your consultation call. You will schedule your consultation call on the following page.
  • Do you have any experience with psilocybin or other psychedelics, whether recreational or therapeutic?*
  • Do you have experience with non-ordinary states of consciousness such as those induced by meditation, breathwork, or hypnosis?*
  • Do you feel any of the following are barriers to you accessing psilocybin services? (select all that apply)?*

  • Mental Health and Medical History

    These questions will help our staff best align you with an appropriate program and the most qualified licensed facilitator.
  • In the past, have you ever participated in mental health therapy or counseling?*
  • Currently (now), are you participating in mental health therapy or counseling?*
  • In the past, have you ever participated in an outpatient mental health program, other than traditional counseling?*
  • Currently (now), are you participating in an outpatient mental health program, other than traditional counseling?*
  • In the past, have you ever received mental health care for any of the following complaints? (select all that apply)*
  • Currently (now), are you receiving mental health care for any of the following complaints? (select all that apply)*
  • Do you have a family history of psychotic disorders?*
  • Have you ever been hospitalized for a mental health issue?*
  • Are you having thoughts of causing harm, or wanting to cause harm, to self or others?*
  • Do you have a history of causing harm, or wanting to cause harm, to self or others?*
  • Do you feel you currently have adequate mental health support systems in place? This may include such things as a therapist or counselor, community group or spiritual community, friends, family, etc.*
  • Currently (now), do you take any medications for any reason?*
  • In the past, have you taken any medications for mental health concerns/issues?*
  • Have you taken lithium in the past 30 days?*
  • Are you currently pregnant?*
  • Are you currently breastfeeding?*
  • Do you have a history of uncontrolled blood pressure or heart disease?*

  • Additional Information

  • Have you ever served in the Armed Forces?*
  • Are you interested in a private session or being part of a group session?*

  • List of Drop Thesis Licensed Facilitators

  • Are there particular Drop Thesis facilitators your are interested in working with (you can select multiple)? You can click the link above to learn more about our facilitators!*

  • Hit "SCHEDULE" below to book your consult on the next page.

     

  • Privacy and Sharing of Information

    By submitting this form, I authorize the service and its associated facilitators to collect my personal and service related information. In addition, I authorize the service center and its associated facilitators to communicate with a referring organization or individual as deemed necessary for my beneficial treatment. I also understand that my personal and service related information information is confidential and will only be disclosed to third parties with my permission.

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