Bendable Psilocybin Program Application Logo

  • Bendable Psilocybin Program Application

  • Screening Application Information:

    Hello and welcome to the Bendable Therapy Psilocybin Wellness Program screening application. Completing this application is the first step to beginning our program. Please see the figure below for an overview of what the Bendable Psilocybin Wellness Program looks like. When filling this application, please be as complete as possible in your responses and take the time needed to answer all questions. Congratulations on taking the first step of your psilocybin journey!
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  • For additional details on our Psilocbyin Wellness Program, please refer to this program overview.


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  • Psilocybin Intentions and Readiness

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  • Mental Health Questions

    Current Conditions

  • Mental Health Questions

    Past Conditions

  • Medical Questions

    Current conditions

  • Medical Questions

    Past conditions

  • Additional Information

  • Optional Demographic Information

    This information is voluntary but supports our ability to communicate and develop access and equity programs.

  • Bendable Privacy and Information Sharing Policy

    At Bendable, we value transparency and integrity. This policy explains how we collect, use, and share your information—starting with your Screening Application and continuing throughout your engagement with us.

    Types of Information:

    • Personal identifying information: e.g., your name and contact details.
    • De-identified information: details about you without identifying data.
    • Aggregated information: summarized, anonymized data (e.g., total clients served).

    Howe We Use and Share Information:

    We use your personal identifying information only to support your care and operate Bendable. We may share it with:

    1. Licensed service centers and facilitators involved in your care.
    2. Technology providers and collaborators who help us deliver and improve services.

    We do not sell your data or share it beyond these purposes unless legally required or with your written consent.

    De-identified and aggregated information helps us measure impact, improve care, and report to partners and funders.

    Your Rights:

    You have the right to:

    1. Ask questions or seek clarifications about this policy or our information practices at any point now or in the future at contact@bendabletherapy.org.
    2. You may refuse to share information by not completing the Screening Application. Doing so means you won’t be able to access Bendable’s services.

  • Thank you for completing the Bendable Therapy Psilocybin Wellness Program application. We will be in touch. Take good care.

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