TheraPsil's Training Program Application Form
Thank you for your interest in TheraPsil's Prescriber Training Program and for your commitment to psychedelic psychotherapy. 

This training has been co-created by Jagpaul Deol, Dr. Valorie Masuda, and Dr. Jean-Francois Stephan. The intention is to fully prepare healthcare professionals to safely and effectively prescribe psilocybin to clients under Canada's Special Access Program (“SAP”).

Please fill out the questions below to the best of your ability.
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First Name  *
Last Name *
Pronouns *
Which cohort are you applying for? *
Email *
Phone Number *
Address  *
City  *
Postal Code *
Province *
Country *
Local MP
What is your highest level of education? *
What is your designation? *
Are you currently registered and in good standing with a professional association or regulatory college with a code of ethics and disciplinary body?  *
Name of the professional association or regulatory body
*
What is your registration number? *
How many years have you been working full-time in your designated field? *
In which area(s) do you specialize? *
Do you belong to a marginalized group?
Why do you want to participate in Prescriber training for Psychedelics?   *
If you're comfortable, please detail any personal or professional experience with psychedelics.   *
Anything else you'd like to share with us?
How did you hear about us? If you were referred to this program by a TheraPsil member, please name them:
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