Our Somatic Mind

Test OSM

2026-07-17 – 2026-07-19Netherlands

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Application

The legal consent text below is a placeholder and must be replaced with lawyer-approved wording before go-live.

Your details

First name

Last name

Email address

We send a confirmation link here. Use an address you can access.

Date of birth

Phone number

Address

Health screening

These answers help us assess whether this retreat is safe and suitable for you. They are stored encrypted.

Do you have any current or past medical conditions?

For example heart conditions, epilepsy, diabetes, pregnancy. List everything relevant.

Are you currently taking any medication?

Include prescription and over-the-counter medication, dosage if known.

Do you have a personal or family history of psychiatric conditions?

For example psychosis, bipolar disorder, schizophrenia, severe depression.

Are you currently in psychiatric or psychotherapeutic treatment?

Yes

What is your previous experience with psychedelic substances?

Substances, approximate frequency, last use. Write "none" if you have no experience.

Have you ever been diagnosed with a substance use disorder?

Yes

What is your intention for joining this retreat?

Emergency contact — full name

Emergency contact — phone number

Emergency contact — relationship to you

Consent

Consent to processing of health data (required)

Consent to processing of registration data (required)