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2026 - PRIVATE CEREMONY INTAKE FORM
Thanks for your interest in a private magic mushroom ceremony at our centre. To make sure you come at the right place in the right time, we ask you to answer following questions with sincerety.
 
If you want to join a private ceremony with another person, ask her/him to fill out a form her/himself. Don't try to answer this form for another person!

Do you agree on our sign our Participant Waiver and Release Agreement on your arrival?
Yes, I do

Visit this webpage to read the Waiver.

  • FAQ page

  • Choose: Safety

Would you like to use our pick up / drop off sevice (Twello train station)?
Yes please
No thanks
Which medication do you use? Also if you did use some of these meds in the past, inform us. Several answers possible.
How depressed have you felt in the past year?
I feel never / hardly never depressed
I've been sometimes a little bit depressed
I've been often depressed
I feel very depressed all the time
Do you have suicidal thoughts?
No, never
Yes, I did in the past (longer than 5 years ago) but not anymore
Yes
Are you haunted by memories, flashbacks, or nightmares about a certain event?
No
Yes
Sometimes / a little bit
Do you have social anxieties?
No, not at all
A little bit / in certain situations only
Yes, I do
"The sadness I feel makes it difficult for me to function in my personal, social, or work life"
Not true, I am overall happy
Sometimes true
Very true
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