Submit your applicaton.

Application Process

If you have any questions, please write to info@arcadiahealing.com

Name

First Name

Last Name

Phone Number

Location

City/State/Province/Country

Subject

Please write Application in the subject. (If you have questions, please write to the email at the bottom of the page)

Gender

Male

Female

How old are you?

You must be 18+

Birthday

YYYY

How did you hear about Arcadia Healing Sanctum, (please list below)

Do you want to incorporate Psilocybin into your retreat?

Yes

Not sure

Please answer the following questions in regards to health history, if you would like to use Psilocybin in your retreat

Do you or someone in your family have a history of mental illness? Please describe below

Why would you like to participate in a Psilocybin retreat?

What would you like to get out of your experience?

Are you currently taking any SSRI/SSNI's?

Yes

If Yes, Please list below with dose

Do you suffer from any personality disorders and if so have you sought treatment?

List your Emergency Contact

Anything you would like to add?

What date would you like to do your private retreat?

YYYY