Do you currently feel emotionally supported?*
Are you currently working with a therapist, counsellor, coach, mentor, physician, or other healthcare practitioner?*
Please indicate whether you currently have or have ever experienced any of the conditions below.*
Have you been admitted to a hospital or emergency department during the past five years?*
Are you currently under investigation, awaiting testing, or awaiting treatment for a medical condition?*
Has anyone in your immediate biological family experienced any of the following?*
Have you ever undergone surgery or a significant medical procedure?*
Do you have any non-food allergies or sensitivities?*
Please list all medications, vitamins, herbs, supplements, hormones, peptides, microdosing protocols, and health or wellness products that you are currently taking or have taken within the past 90 days.
Have you recently stopped, reduced, or changed any prescription medication without guidance from the prescribing healthcare professional?*
Have you ever experienced or been diagnosed with any of the following?*
Have you ever been hospitalized or admitted to a treatment facility for a mental-health concern?*
Are you currently receiving treatment for a mental-health concern?*
Are you currently experiencing thoughts of suicide or self-harm?
Have you experienced suicidal thoughts or self-harm behaviours in the past?
Have you ever attempted suicide?
Have you ever experienced psychosis, hallucinations outside of intentional psychedelic use, severe paranoia, mania, or a significant loss of contact with reality?*
Have you used any of the following regularly, heavily, or within the past 12 months?
Are you applying primarily for substance detoxification or interruption of compulsive substance use?
Have you previously attended detoxification, rehabilitation, residential treatment, outpatient treatment, or a recovery program?
Are you currently sober or abstinent from any substance?
Required acknowledgement checkboxes
