Dancing spores intake form

Join the microdosing dance!

Expresse here your interest and interrogations. We will connect with you soon to further explore your upcoming journey.
Please note, the information provided here is confidential and will only be used by DancingSpores; it will not be shared with any third parties.

Once this form is filled out, you will have acces to our agenda to schedule a free 30-minute connexion appointment.
Your Name*
Your E-mail*
example@example.com
Phone Number*
We use Signal to contact you during the program
What journey are you applying for?*

Individual coachingIndividual Microdosing coachingGroup Microdosing journeyOther
Do you have prior experience with psychedelics?*

YesNo
With which psychedelic substance(s)?*

Psilocybin (mushrooms, truffles)Mescaline (San pedro, peyote)LSDOtherNone
Why do you want to microdose - how do you think it will help you personally?*
Is there any other personal, professional or academic experience you’d like to share with us?
Microdosing may not be suitable for everyone. To ensure we craft the most supportive coaching journey tailored to your needs, please answer the following questions.
Are you experiencing or have you experienced any of these (neurodivergency) conditions or episodes in the last 24 months? If so, please explain. Heart disease, Diabetes, High cholesterol, Depression, Anxiety, Stress, Asthma, ADD/ADHD, Addiction, Autism, Phobias, Severe insomnia, Obsessive compulsive disorder, Treatment for depression, Suicide attempt, Disordered eating, Schizophrenia (you or close relativ), Bipolarity (you or close relativ), Psychosis, Trauma, Complex Trauma*
If you have recently consumed any medication or psychoactive substance, please indicate which ones and why. Examples of medication: Antidepressants, Antihypertensives, Depressants, Vasodilators, Antipsychotics, Barbiturates, ADHD medication Examples of psychoactive substances: Alcohol, Cocaine, Amphetamines, Other Stimulants, Opiates, Mescaline, Psilocybin, Cannabis and similar substances. IMPORTANT: We do not encourage unsupervised and medically unguided tapering of prescribed substances *
Do you have any questions that you would like us to answer when we contact you?*
How did you hear about us?
I confirm that I understand, agree and consent to the following:*

I have truthfully declared my health history, conditions, consumed substances and commitments in this form.I understand that Dancing Spores is not responsible for the inappropriate use of microdoses, nor for the consequences that could be incurred by this practiceI understand that registration to thoses offers does not include microdosing substances.I take responsibility for legally and reliably sourcing my own microdosing substance
Thank you for your interest! We're excited to get to know you in person and start this microdosing journey together. You’ll be automatically redirected to our agenda to schedule your free meeting.
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Join the microdosing dance!