Submit an Inquiry

Making a change in your life for the better is such an important and exciting step and we look forward to helping you on your path. Please fill out the form below so that we can learn more about you and what you are looking to achieve with Iboga and our ceremonies.

Please ensure you disclose all information about your current and past medical history, honestly and openly. It will aid us greatly in your treatment. All your information will remain confidential only shared within our core team.

This is not a form to disclude you from treatment so please be honest about all your medication/drugs/conditions so we can give you the best advice. Knowing about your overall health, medical history, and medicine use allows us to understand your current situation and make sure that Iboga is safe for you. 

We will contact you shortly after receiving your form to discuss the process.

This form and our waiver form must be completed before the ceremony.

If you do not wish to do the intake yet and only wish to talk to find out if Iboga is right for you, please email us with a contact number and we will set up a call.

Rootedwaters@protonmail.com