Soul Surfing Psychedelic Prep

Register for the six-week client course

Complete this form once, then continue directly to secure payment. A free or scholarship code can be applied before checkout.

Your registration

Required fields are marked with an asterisk. Optional background information helps the team tailor the program to participants.

Full name *

Email address *Email updates (optional)

Have a free or scholarship code?

If Dr. Gold gave you a code, enter it here to register at no charge. Leave blank if you don't have one.

City & State of residence *

Optional — helps us tailor the program

Education & occupation

Relationship status

Race

Gender identity

Religion / spirituality

Have you experienced psychedelics before?

Are you currently working with a psychotherapist, coach, medical provider, or holistic healer?

What psychedelic are you most interested in pursuing, and for what purpose?

Research & consent

All information will be stored anonymously.

I am willing to participate in research to improve this program and expand the field of psychedelic studies by completing pre- and post-assessments. I am willing to allow my worksheet data to be used (anonymously) for research purposes. I agree to complete assessments pre-course, one week post-course, one week after my psychedelic experience, and at a one-year follow-up.

Signature (type your full name) *

Date *