Thank you for your interest in The Art of Microdosing our foundational 8 week programme to master change.
Please complete this form fully and honestly. All personal information is strictly confidential and will be treated securely.
Thank you,
Naz & Rachel
Co-Founders, Women are the Medicine
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About you and your current situation
You and Psychedelics
Please provide a brief summary of your history with psychedelics (if applicable), and future intentions regarding working with these medicines.
If you would rather discuss the information in this section with us in person, we can do so on our Discovery Call.
Medical Declaration
Potential Contraindications
It's important to recognise that, as with any compounds taken medicinally, there are both physiological and psychological conditions which need to be screened out when it comes to psychoactive substance use.
Not all of these contraindications rule out the use of psychedelics - they do however need to be considered very carefully, as they can cause serious long-term damage if not acknowledged before going into a psychedelic experience.
I hereby confirm that, to the best of my knowledge, the provided information is true and accurate.
I agree that by providing my email and phone number, I consent to receive email and text messages from Women are the Medicine. in relation to my application.