5-MeO-DMT Application Form

Step 1 of 5

  • SERIOUS ENQUIRIES ONLY. Expect us to call for pre-consultation info.

  • Please note that EVERY field must be filled out for you to be able to submit this form.
  • Medical Information

  • Please answer these questions honestly and to the best of your knowledge. 5 MeO DMT is a powerful entheogen and has some physical, psychological and pharmacological contraindications. We need to know if there are any concerns in order to assess if this work is safe or appropriate at this time.