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Application for Psilocybin Assisted Therapy Pilot

I acknowledge my intent to participate in an observational Pilot program involving psilocybin-assisted therapy for veterans. This Pilot program is designed to evaluate the impact of psilocybin, administered in conjunction with psychotherapy, on mental health outcomes such as PTSD, depression, anxiety, substance use, and more.

As part of the Pilot program, I understand that I will undergo standardized assessments before and after treatment to measure changes in psychological well-being and determine the effectiveness of the therapy.

To assess your eligibility, we need to collect the following information. This information will not be shared or sold and will be protected under the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Personal Health Information Protection Act (PHIPA).