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Welcome
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18
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1
Have you, a parent, or a sibling been diagnosed with schizophrenia?
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YES
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2
Do you have any significant cardiac-related challenges?
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If unsure select "No" and ask on your consultation call.
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3
Are we the right budgetary fit for you?
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We know that legal psilocybin is expensive and is unfortunately not covered by insurance. With that in mind we have worked hard to offer a range of programs to hopefully fit your budget. First, we offer microdosing for $200 - $300 per month. Next, we offer group macrodosing for $1,600. Lastly, we offer one on one macrodosing sessions for between $2,000 to $3,500. If these do not work for your budget select "No" below and we will offer suggestions for financial assistance for you.
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4
Name
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First Name
Last Name
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5
Date of Birth
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Under Oregon State Law you must be over 21 years of age to work with us.
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6
Email
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By providing your email address, you consent to receive updates and information about our services via email. We respect your privacy and are committed to sending only meaningful and relevant communications without spam.
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7
Phone Number
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By providing your contact number, you consent to receive text messages or phone calls from us regarding our services. We value your time and privacy, promising to keep communications relevant and free from spam.
Please enter a valid phone number.
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8
Preferred Pronoun (optional)
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she/her/hers
they/them/theirs
he/him/his
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she/her/hers
they/them/theirs
he/him/his
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9
Address
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Street Address
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State / Province
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Afghanistan
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Isle of Man
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Western Sahara
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Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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10
Are you local?
Do you live in the Portland metro area (including Southwest Washington)? We are trying to understand if you are traveling to us for treatment or if you live in the area. If you are further than a one hour drive from us please select "no".
YES
NO
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11
What is your experience level with psilocybin?
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This would be my first experience
I have tried it once or twice
I have had many experiences
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12
Mental Health Background
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Please describe your mental health background and why you're interested in a facilitated psilocybin experience. Please share at least a few sentences.
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13
Medications
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Please share any prescription medications that you are currently taking, including the does and how long you've been taking them. If you aren't taking any please write "N/A" below.
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14
What service are you interested in?
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Macrodose (a large therapeutic dose)
Microdose (a small non-hallucinogenic dose)
Both Macrodose and Microdose
Not sure
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15
Are you open to a macrodose group session?
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Group sessions are optional, but offer some key advantages. These sessions are more affordable, and many report that their psilocybin experience is enhanced by going through it with a group. Joining a small group of people who share an intention for self-growth creates a 'container' that deepens the transformational power of psilocybin. Initial reactions to this idea can often be reluctance or fear, yet it comes highly recommended by those who have experienced it. You would join a carefully selected group comprised of 5 - 8 participants and 3 - 4 facilitators. In the preparation and integration phases there are individual and group meetings that build a high-degree of trust and connection. The psilocybin experience takes place in a group setting, yet each participant has their own space to allow for a private journey experience. The total cost to join a group program is $1600.
YES
NO
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16
What is your macrodose budget?
*
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The total cost for a solo macrodose experience ranges from $2,000 - $3,500+, which includes the psilocybin, room rental, and facilitation. Pricing is based on your choice of Facilitator and experience room. We also offer group programs for $1,600 total, and we have options for financial assistance if needed.
Group session ($1,600)
Solo session ($2,000)
Solo session ($2,000 - $3,500)
Solo session ($3,500+)
I need financial assistance
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17
What is your total budget for this?
We understand things are tight, let's see if we can help.
Total budget for a macrodose session
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18
Facilitator Preference (optional)
Are there any specific facilitators that you'd like to work with? Please visit our
Team page
and list their names here. Or do you have any general preferences? For example: gender, age, expertise, life experience, etc. If you don't have any preferences just click "Next" below.
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19
When would you like to have your experience?
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Within three months
After three months
I'm open or unsure
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20
Please verify that you are human
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