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I am willing to experience discomfort during the session, including nausea, restlessness and emotional distress. *
I am willing to experience periods of insomnia post session. *
Your personal information will be held in total confidence. If you agree, we would like to use data about your session, excluding all personal details, to be used to further T.Iboga/ibogaine knowledge and research.

I agree to allow this data, with all identifying details removed, to be used to further knowledge about T.Iboga/ibogaine: * 

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