Ketamine Retreat Sign Up

Name *

First Name

Last Name

I would like to sign up for

April Retreat

May Retreat

Both

I would like to stay in the

2 Bedroom Condo Lodging( Up to 4 ppl)

Hotel Lodging ( Private single person stay)

Ketamine History

Have you been treated with ketamine before?

Yes

No

Rather not say

Are you interested in a Wellness Retreat without Ketamine ?

If yes please indicate which weekend?

April 25th weekend

May 16th weekend