Retreat Application | The Wellness Den

Why are you interested in this retreat?

What steps have you already taken in your healing journey?

Any current or past medical issues?

Current medications

Past/current mental health treatment history? (Please be as detailed as possible)

Please elaborate on type and duration of psychotherapy, as well as other relevant information regarding healing journey. (Please be as detailed as possible)

Please elaborate on psychedelic experience(s). If none, put N/A.

How do you feel about taking ketamine during the retreat? Any concerns?

Do you require a payment plan? If so, would you like bi-monthly or monthly payments?

Any questions or concerns?

Application for Psychedelic-Assisted Wellness Retreat