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MDMA Prescriber Training Program Application Form

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

Please Note: Please note this training is an asynchronous Online Training.

This training has been co-created by Jagpaul Deol, Dr. Ingrid Pacey, and Dr. Houman Farzin. The intention is to fully prepare healthcare professionals to safely and effectively prescribe MDMA to clients under Canada's Special Access Program (“SAP”). By submitting this form you agree to received email communications regarding training programs from TheraPsil NPO.

First Name *

Last Name *

Pronouns

Email *

Contact Information:

Phone *

Address *

City *

Province *

Country *

Postal Code *

Professional Eligability:

Designation for Eligibility *

Specializations *

Highest Level of Education *

Professional association or regulatory body *

Registration number *

Registration Expiry *

About you:

Do you identify as part of a Marginalized group?

Who are you?

Is there current interest in your patient population base?

If you are comfortable, please share any personal or professional experience with psychedelics.

Why do you want to participate in this training? *

Are you also interested in applying for TheraPsil’s Psilocybin Prescriber Training?

How did you hear about us? / Referrals *

Please verify your request. *