Thank you for completing the brief autobiographical questionnaire below — an important first step for safe participation in Shepherd U Holdings retreats. This confidential form, developed with medical guidance, helps us identify any factors that could impact safety or the group experience.

Please know that our retreats are not clinical or medical treatments; this process is for safety and support only. Participants should be in good mental and physical health and disclose any history of serious mental health conditions. Some medications may need to be adjusted to ensure compatibility, and we’ll follow up with guidance if needed. Certain health conditions, such as heart issues, may also require consultation with your doctor. No prior psychedelic experience is necessary — just a spirit of openness. Full participation in preparation and integration activities is encouraged. Payment plans are available for our programs.

By submitting your questionnaire, you confirm you have reviewed these considerations and will seek medical advice if recommended.

First Name

Last Name

Phone *

Email *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Address

Street Address

City

State

Country

Postal code

Age

How did you hear about Shepherd U Holdings?

Are you currently taking any prescription medications?

Are you currently under a physician's care? (And, if so, for what?)

Do you have prior experience with psychedelics? (And, if so, what experience do you have?)

Have you ever had any adverse reactions to alcohol, drugs, or any other consciousness-altering substances? (And, if yes, please describe what happened.)

What are your hopes, expectations, and any concerns in participating with us?

This work can lead to profound shifts, and it’s important to have support in place before, during, and after the retreat. Do you have friends, family, or trusted professionals, like a therapist or coach, who know you are applying and can support you?

We look forward to participating with you.