Health Form - MindTravellers

I declare that (if necessary in consultation with my doctor) I am prepared to abstain from alcohol, drugs, medicines, nasal sprays and/or supplements for at least three days, and in some other cases two weeks, for my own health and well-being.

Yes

No

Do you have high blood pressure or heart defects?

Yes

No

Do yu want to participte in th University of Maasticht' research?

Yes

No

Do you have experience with Ayahuasca or other entheogenic medicines?

Yes

No

I declare that I have answered this fully and truthfully.

Yes

No

I agree to the terms of delivery

Yes

No