How Have Psychedelics Impacted You? Story Submissions
This submission form is for anyone who would like to share their personal stories regarding the positive social, emotional, mental, or physical impact of using psychedelics. These stories will be shared over our social media platforms and with your lawmakers to help increase access to psychedelic therapy.
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What is your name? (First, Last) *
What is your email? *
Where are you located (City, State) *
What is your age?
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What is your gender expression?
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Would you like to remain anonymous or non anonymous? *
Are you open to your story being shared on our social media platforms in the form of a text graphic? *
Are you open to being contacted for a video interview? *
Prompt ideas: How have psychedelics impacted you? In what ways have psychedelic substances/plant medicines aided your social, emotional, or mental health? Do you prefer taking psychedelics by yourself or in a group setting? Are you a trip-sitter, coach, teacher, or practitioner? What would the decriminalization or legalization of psychedelics mean for you? Etc *
If you prefer to send a document rather than use the above prompt, please send your story here:
Do you know anyone that would be open to sharing their story? If so, would you be open to sharing this form with them?
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Do you consent to us storing your information, adapting your story, and sending you periodic emails related to this project? *
Optional: Do you have any suggestions or feedback regarding this form?
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This form was created inside of Illinois Psychedelic Society.

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