Taking this questionnaire is required before participating in any psychedelic related events or services at Neuma. The questionnaire could be used as a self- assessment, or may also be part of a structured psychedelic safety interview to participate in ongoing classes, psychedelic therapy, or our training program. Please return before your scheduled session or interview and contact your facilitator with any questions.

A Few Notes About the Questionnaire:

Psychedelic experiences are very safe, but they are not for everyone. None of the questions, except the first one about pregnancy, will automatically disqualify you from participating in psychedelic events at Neuma. This is an opportunity to discuss safety and help your facilitator create the necessary preparation and integration support so they can provide the safest and most appropriate container for your experience. Participation agreements and informed consent documents may also be required to participate in any psychedelic medicine programs at Neuma.

Although most experiences are positive and deeply meaningful, psychedelics often show us what we need to see, not what we always want to see. Therefore, being approved to participate in an experience does not guarantee an easy or enjoyable experience.

Contraindications (reasons not to participate in a psychedelic experience) are included in the specific service’s participation agreement and listed throughout these questions. With the right support, private individual sessions or small groups can be facilitated to treat significant clinical concerns that might not be as safe to engage in a large group setting, celebratory experiences, or the training program.

If you have ANY concerns whatsoever about your physical health, please speak to a doctor before participating.  If you have any concerns about your mental health, and your capacity to participate in any event safely, we have licensed mental health practitioners that can support you in your decision making process as well.

To members of BIPOC, LGBTQ, and other marginalized communities who experience trauma caused by generational systems of oppression, none of these questions are intended to exclude you because of the ongoing traumas of racism and other forms of discrimination that you commonly face. Comments are provided under some of the questions to provide additional context about why certain questions are asked.