Applications

Please answer all questions as accurately as possible, paying special attention to medical and substance use history. Incomplete or false information can lead to unintended consequences that may greatly effect your treatment and may lead to serious harm. Keep in mind that most, if not all, of the Ibogaine related complications or deaths have occurred because of heart problems, inaccurate reporting of substance use, and/or use of opiates during or just after treatment. Your honesty helps to ensure your safety.

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The links below will lead you to our secure on-line application. For active substance use please select Detox Application, if not addressing current chemical dependency please use Non-Detox Application.