IBOGAwaken Full Intake Application
Qualifying health assessment /disclosure statement, please take the time to fill out the information below.
We invite you to fill out our qualifying intake form, there are some contraindications when taking IBOGA and we need to understand your current health situation. Once we receive the submitted form we will contact you on your chosen time to discuss the next steps.
Please note: all fields are required if you do not have an answer please type N/A, thank you for taking this time to complete the required details.
A standard drink = 1 nip (30ml) spirits, 100ml wine, 10oz/285ml beer
2 standard drinks = a pint (568 ml), a large glass of wine (200ml)
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