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Before we confirm participants we ask everybody to answer a few questions just to ensure we are a good fit for each other, that we understand a little bit more about you and your needs. We will then invite you to have a 15min conversation on Skype so we can both get to know each other a little which is of course very important for both you and us embarking on such a journey together. This gives you a chance also to feel if we are a good fit for you and if we are people you would like to connect with in this way.

If you have a question, please first take a look at our FAQ , we receive many inquiries so this will allow you to receive your answer without needing to wait for our response.

First Name:*

Last Name:*

Email:*

Phone Number*

When is your birthday? (The year matters so we can make sure you are over the age of 18.)*

Which retreat are you interested in?*

Tell us briefly about yourself. Where do you live etc?*

Is this going to be your first psychedelic experience?* YesNo

Tell us about your experience with related practices (such as meditation, breath work, sound healing, dance, yoga, etc)*

Tell us about any past or present mental health conditions (including depression,psychosis, anxiety and PTSD)*

Please mention briefly any known traumas or difficult events you have experienced in both childhood and as an adult*

Have you been diagnosed with Schizophrenia, Bi-Polar Disorder or Borderline Personality?*
YesNo

What is your family history of mental illness? If you have answered yes above please provide your diagnosis here with your family history. *

Are you taking medications? If yes, please provide the name, dosage, frequency of use,as well as details of the condition that is being treated. Please note that you need to be off any medication that interacts with Psilocybin in order to join us for this Psychedelic journey (such medications include MAO inhibitors, Lithium, Stimulants, Antihistamines and most antidepressant medications with the exception of SSRIs, which you can take at your own risk). Let us know if you are willing to taper off them together with your doctor. Please check the the medications list under our FAQ on the website before submitting your questionnaire. We are not medical doctors and therefore cannot offer you advice on your medications.*

Do you have suicidal thoughts? If so how often and how recently? *

Have you ever had a suicide attempt? If so, when did this take place? *

What is your intention for the Retreat? What shift in your life would you like to experience?

Are you interested in a private (6.200 Euro) or a shared double room (4,600 Euro)?
(If applying for a private retreat select any option to complete the form as you will provide your own accommodation)*

Will you pay in full or do you prefer monthly payments?
(Payment Plan available for The Shift Group retreats only, Private ceremonies do not have this option )*

Which time zone are you in and what times would work best for you/do not work for you?

How did you hear about us?*

We will be in touch very soon.

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