Sign-up cannabis event

First name *

Last name *

Company

Email *

Phone *

Date of birth *

Streetname + number *

Postcode *

City *

Do you have experience with cannabis? *

In what form (smoking, vaping, edibles)? *

When was the last time, and for what purpose? *

How has your experience with cannabis been? *

Have you ever had a bad experience with cannabis or psychedelics? If so, can you tell us more about it? What do you think caused it?

What is the reason you’re signing up for this retreat? *

What would you like to know, explore, learn, or process? *

Do you ever use mind-altering substances? *

Yes, namely: *

Are you currently taking any medications? *

Yes, namely: *

Do you suffer from psychological issues? *

Yes, namely: *

Are there any mental health issues in the family? *

Yes, namely: *

Have you, or a direct family member, ever experienced psychosis? Or suffered from bipolar disorder?

Do you suffer from heart conditions or high blood pressure? *

Are you pregnant or breastfeeding? *

What is your primary reaction to fear? *

What helps you the most in such moments? *

Which important loved ones have passed away? *

What events in your life have made a deep impression on you? *

What recurring patterns are holding you back? *

Can you tell us something about your background? *

Think about family, upbringing, and what you have learned at home.

Are there recurring themes in your family line? *

Think about health, family patterns, traumas, or issues.

In terms of food: what do you really enjoy eating? *

Something you can truly savor

And what do you (prefer) not to eat? *

Allergies, diet, or conscious choices.

Is there anything else that is important for us to know? *

Something that can help us make your experience as pleasant as possible for you.

How did you hear about us? *

Namely: *

Confirmation *

I have answered the above questions truthfully

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