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Unfurl:
A journey of expanding from your center with Iboga and 5-MeO-DMT

Thank you for taking the time to complete this intake form thoughtfully and honestly. This isn't a test you can fail; it's how we make sure this experience is safe and right for you, and how we prepare to hold you well on the journey day. Everything you share here is kept strictly confidential and used only to support your care.

If anything here brings up a question, please don't guess; reach out to us directly. We'd rather have the conversation before the day than discover something during it.

1. About You

Full name

Preferred name

Personal Pronouns

Email

Phone

Emergency contact - Name, phone number and relationship to you

2. What Brings You Here

How did you hear about this event?

If "Other" above, please elaborate:

What draws you to this journey, and what are you hoping to move through or toward?