Intake form

Name *

Email address *

What is your branch of service?

Please select at least one option.

Army

Navy

Air Force

Marines

Coast Guard

National Guard

Special Forces (Select if you served as a Navy SEAL, Delta, Green Beret, MARSOC, etc..)

What are your primary reasons for seeking support?

Please select at least one option.

PTSD

Anxiety

Depression

Social Isolation

Traumatic Brain Injury

Have you participated in any similar retreats before?

What is your preferred method of contact?

Do you have any specific dietary restrictions?

Which type of golf retreat would you be interested in?

Please select at least one option.

Relaxation Socialization

Networking and Group Therapy

Education on Psychedelics

Therapeutic Sessions and Holistic Therapy Sessions

What is your current mental health status?

What additional support services are you interested in?

Please select at least one option.

Ibogaine Therapy

Coaching and Peer Support Groups

Holistic Healing and Education

Mobile Healing Units

Please provide any additional comments or questions you may have.

Additional questions or comments

Zero Dark Birdie