Sign up for a session with MDMA On this page you can fill in your details. We will review your details within one business day and if we can find no contraindications we will schedule a session. Fill in your details without obligation via the form below. MDMA therapy registration First name Surname Age Place of residence E-mail Phone number Reason MDMA session Drug use history Drug use today Mental disorders Suicidality/psychosis I am struggling with suicidal thoughts I had a psychosis Medicines Physical ailments Additional info AV I agree to the Terms and Conditions Truth I have completed the intake form completely and truthfully General Terms and Conditions To register