IPI Psychedelic-Assisted Therapy Training Application

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Email* This field is required.

example@example.com

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First Name* This field is required.

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Last Name* This field is required.

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Address

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Cell Phone Number* This field is required.Please provide a mobile phone number that can receive text message notifications regarding your application status.

Area Code

Phone Number

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Education: (Please List Your Highest Level of Degree)* This field is required.

High School Diploma

Some College, No Degree

Associate's Degree

Bachelor's Degree

Master's Degree

Doctoral Degree (PhD, MD, DO)

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As a Medical Provider, Do You Have 1,000 Direct Contact Hours of Mental Health Interventions.

Yes, I Have 1000 Direct Contact Hours

No, I Do Not Have 1000 Direct Contact Hours

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Please Choose Your Current License Status* This field is required.

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What is Your Level of Experience Providing Psychedelic-Assisted Therapy* This field is required.

I Currently Provide Psychedelic-Assisted Therapy Services

I Have Done Training, But Not Practicing Yet

I'm Looking For Training, But Not Practicing Yet.

I'm Just Researching and Looking For More Information