5-Day All-Inclusive Oregon Psilocybin & Breathwork Retreat: 2x Licensed & Regulated 🍄 Journeys

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1 Welcome

2 Price

3 People in your group

4 Participant Info

What is your intention of coming on a Confluence Retreat and/or participating in a group psilocybin experience? *	Please share as little or as much as you'd like. At this stage of the process, there is no reason to share more than 3-4 sentences maximum, since we will discuss it more during the Exploration Call.
Do you have previous experience with psychedelics? *	If yes, please describe a little about your experience.
Do you have any ongoing relationship or engagement with a coach, therapist or support group? *	Having external support, beyond what is provided on the retreat, is a helpful way to ensure you get the most out the retreat experience. If yes, please briefly share the nature and frequency of your coach, therapist or support group.
Do you have a community or people in your life who you can share openly, without judgment, the challenges and struggles you face? *	Yes No Healthy relationships, even if they are just with a small number of key individuals in our lives, are an important part of being able to integrate the experience of a transformational psilocybin retreat.
Are you currently being treated by a medical, clinical, or other healthcare provider for a condition? *	If yes, please briefly describe the condition and the treatment, including any medications you are taking. Please list all medications so we can access any potential interactions with psilocybin.
Will you be 21 years or older at the start date of your intended retreat? *	Yes No
Have you taken the prescription drug Lithium in the last 30 days? *	Yes No
Are you having thoughts (or have recently had thoughts) of causing harm, or wanting to cause harm, to self or others? *	Yes No
Have you ever been diagnosed with active psychosis or treated for active psychosis? *	Yes No
Have you ever been diagnosed with schizophrenia or bipolar 1 disorder *	Yes No
Are you pregnant or breast feeding? *	Yes No
Do you have a heart condition, epilepsy or history of aneurysms? *	Yes No
Do you experience extreme fatigue? *	If yes, then do you know the reason you experience extreme fatigue? Please share if so.
Are you experiencing any substance use or addiction challenges? *	If yes, please describe the substance use or addiction challenges, including what substances are being used.
Have you ever had an allergic reaction to consuming mushrooms or other fungi? *	If yes, please describe the allergic reaction experienced or known allergy.
Are you currently taking any medications that might need to be consumed during a psilocybin administration session? *	Psilocybin administration sessions will last for approximately 8 hours and will occur between the hours of 10am and 6pm. If yes, please share what medications might you need to take during the psilocybin administration session, including frequency.
Is your life in a place that can accommodate some instability? *	Yes No Psilocybin journeys can unearth things you were not conscious of within yourself and your life, or help you see your life in a different manner. It sometimes takes emotional and mental energy to work through things that come up, which (depending on your circumstances or what comes up) may introduce some instability into your life.
Is there anything else you'd like us to know about you, your intention to join us on retreat or any questions you are holding so that we can prepare to answer them in the Exploration Call?
Every potential participant must partake in a free 45-minute Exploration Call to confirm their participation in the retreat. Do you agree to complete this step in the booking process? *	I understand We require a free 45-minute Exploration Call to assess and confirm the fit of all participants, ensuring a safe and supportive environment for everyone. If, after completing this call, you are not welcomed to join the retreat, you will receive a 100% refund immediately. This step is crucial for maintaining the integrity and safety of our program.
Payments do not include the cost of plant medicines. *	I understand that payments made through Retreat Guru do not include the cost of: licensed and regulated psilocybin mushrooms and service center fees. Separate payment of $1,000.00 per person to be arranged with the center.Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service.

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Guest 1		First Name* Last Name* Email*
Guest 1		First Name* Last Name* Email*

1 Welcome

2 Price

3 People in your group

4 Participant Info

5 Payment