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Use this form to express your interest in joining the program (please note: spots are limited). Once you've submitted your information, we will connect with you within 7 days to further explore your upcoming journey with us, and answer any questions you may have.

Email *

First name *

Last name *

Cell Phone number * (we use Signal for contact during the program)

City and Country *

Age *

Do you have prior experience with psychedelics? *
Yes, macrodosing and microdosingYes, only macrodosingYes, only microdosingNo

With which psychedelic substance(s)? *
Psilocybin (mushrooms, truffles)LSDAyahuasca or B. caapi vineMescaline (San pedro, peyote)DMTMDMAOther chemical substance(s)Other plant medicine(s)None

Why do you want to microdose - how do you think it will help you personally? *

[OPTIONAL] Are you interested in becoming a microdosing coach or learning how to integrate microdosing in your professional offerings? If yes, please explain.

[OPTIONAL] Is there any other personal, professional or academic experience you'd like to share with us?

Are you experiencing or have you experienced any of these (neurodivergency) conditions or episodes in the last 24 months? If so, please explain.
Heart disease, Diabetes, High cholesterol, Depression, Anxiety, Stress, Asthma, ADD/ADHD, Addiction, Autism, Phobias, Severe insomnia, Obsessive compulsive disorder, Treatment for depression, Suicide attempt, Disordered eating, Schizophrenia, Psychosis, Trauma, Complex Trauma *

If you have recently consumed any medication or psychoactive substance, please indicate which ones and why.
Examples of medication: Antidepressants, Antihypertensives, Depressants, Vasodilators, Antipsychotics, Barbiturates, ADHD medication
Examples of psychoactive substances: Alcohol, Cocaine, Amphetamines, Other Stimulants, Opiates, Mescaline, Psilocybin, Cannabis and similar substances.
IMPORTANT: We do not encourage unsupervised and medically unguided tapering of prescribed substances *

Do you have any questions that you would like us to answer when we contact you? *

How did you hear about us? *
Google/online searchA friendA team memberJim FadimanPaul StametsNew Health ClubExperiential Training InstituteMicrohuascaPsychedelic SocietyAwaken The Medicine Within
Other, please indicate

I confirm that I understand, agree and consent to the following: *
I have truthfully declared my health history, conditions, consumed substances and commitments in this form.I understand that Microdosing Institute is not responsible for the inappropriate use of microdoses, nor for the consequences that could be incurred by this practiceI understand that registration to this course does not include microdosing substances.I take responsibility for legally and reliably sourcing my own microdosing substance, and confirm I can make sure how much volume of that specific substance is used for a full dose or ceremony, so I can measure the quantities required for microdosing by myself.I confirm that I have read and accepted the conditions of the program before applying (the full content of this page and this consent form).I agree to receive communications from Microdosing Institute and International Microdosing Association.I agree that my data is hosted on Google software and cloud storage and accessible to the facilitators for the analysis of my progress. My anonymized data will be used for research and educational purposes.I understand that this 6-week program is introductory and does not qualify me as a microdosing facilitator. Completing it successfully will allow me to access the advanced facilitator training program with special conditions.I will receive newsletters from Microdosing Institute (I can unsubscribe at any time)