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Psychedelic Retreats Africa
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Name
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What type of service are you interested in?
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Ibogaine treatment
Ayahuasca ceremonies
Psilocybin therapy
Safari experience
Have you previously participated in any psychedelic retreats?
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What is your age range?
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18-25
26-35
36-45
46-55
56+
What is your primary reason for seeking psychedelic therapy or retreat?
Do you have any medical conditions we should be aware of?
Are you currently taking any medications?
How did you hear about us?
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What is your preferred date for the retreat?
Do you have any dietary restrictions or preferences?
Which service or services are you interested in?
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Ibogaine treatment
Ayahuasca ceremonies
Psilocybin therapy
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