Remedy - Special Access Program Initial Intake Form
Thank you for your interest in the Special Access Program (SAP) at Remedy. Please fill out this initial intake form to see whether you may be eligible to apply. If you have any questions, please send an email to intake@remedycentre.ca.

Please make sure to click the "Submit" button once you have completed the form.
Sign in to Google to save your progress. Learn more
Please read through the following information to learn more about what the Special Access Program involves (SAP).

What is SAP?

Through the Special Access Program (SAP), health care professionals can support clients in accessing psychedelic treatments that have undergone preliminary research and are not available for sale in Canada.

Treatments involve 1-3 doses of psilocybin or MDMA embedded within a course of psychotherapy. There are a minimum of three preparatory sessions and three integration sessions to follow each psychedelic medicine session. Therapy sessions take place in an office setting and are attended by two mental health professionals, fully trained in psychedelic assisted therapy treatments.

An application to Health Canada involves completing a medical screen with a physician as well as a psychological screen with a registered psychologist. There is no guarantee that an application will be approved by Health Canada. The request must be for treating a client with a serious or life-threatening condition where conventional treatments:

          - Have failed
          - Are unsuitable or
          - Are not available in Canada

Please note that completing this form does not mean that you are approved for the SAP program, but is an initial step meant to help us determine whether the program may be suitable for your needs.  

Services are provided in English. There is a financial cost associated with SAP.
*
Required
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Remedy.

Does this form look suspicious? Report