Psychedelic Use Self-Check — Digital Form

Self-assessment questionnaire

This test is intended to give a rough estimate of whether a psychedelic experience may be advisable for you at this point in time. It does not replace medical or psychological evaluation and is not a guarantee of safety or benefit.

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The date is automatically set using Central European time.
A. Hard Stops
Only tap items that apply. Tap again to undo.
History of psychotic episodes or diagnosed psychotic disorder
History of manic episodes (bipolar I) or uncontrolled bipolar disorder
Current severe depression with suicidal intent
Current or past severe dissociative disorder
History of seizures or epilepsy
Serious cardiovascular disease (e.g. arrhythmia, recent heart attack)
Uncontrolled high blood pressure
Pregnant or possibly pregnant
Currently in an acute mental health crisis
B. Elevated Caution Factors
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Known psychotic or manic episodes in close relatives (parents, siblings)
Past hypomanic episodes without full mania
Strong family history of severe mental illness
Chronic anxiety or panic disorder
History of trauma that is currently emotionally active
Strong tendency toward rumination or obsessive thinking
Very low stress tolerance or recent burnout
Major life transition or instability in the past 3 months
Sleep deprivation or irregular sleep patterns
Limited prior experience with altered states
C. Current Medications & Substances
Only tap items that apply. Tap again to undo.
Lithium (Quilonum, Hypnorex)
MAOIs – irreversible (Tranylcypromin/Jatrosom, Parnate)
MAOIs – reversible (Moclobemid/Aurorix)
Tramadol (Tramal)
SSRIs (Sertralin/Zoloft, Citalopram/Cipramil)
SNRIs (Venlafaxin/Trevilor, Duloxetin/Cymbalta)
TCAs (Amitriptylin/Saroten, Doxepin)
Bupropion (Elontril, Wellbutrin)
Stimulants – amphetamine type (Elvanse, Medikinet)
Benzodiazepines (Diazepam/Valium, Lorazepam/Tavor)
Antipsychotics (Quetiapin/Seroquel, Olanzapin/Zyprexa)
Beta blockers (Propranolol, Metoprolol)
D. Questionnaire (Likert scale)
Select one option per question.
Section A
Acute psychological stability and manageability
1. When I feel overwhelmed or scared, I usually remain oriented (I know where I am and what is happening) and can still talk.
2. I have not lost control of my behavior (for example: running away, aggression, or self-harm urges) during panic, intoxication, or extreme stress.
3. When I am distressed, I can accept reassurance or guidance from someone I trust.
4. Even when emotions are very strong, I can stay physically calm and avoid impulsive actions.
5. I have not had episodes where I believed others were trying to harm, deceive, or conspire against me.
Section B
Cognitive grounding and reality-testing
6. When I have unusual or intense experiences, I generally understand them as subjective experiences rather than literal truths about reality.
7. Under stress, I usually do not assume that neutral behavior from others is hostile or threatening.
8. I have not had problems clearly distinguishing imagination, thoughts, or inner experiences from external reality while awake.
9. When emotionally activated, I do not easily adopt beliefs or ideas just because someone else suggests them.
Section C
Expectations, intent, and flexibility under difficulty
10. I am not expecting a psychedelic experience to automatically heal me, fix my life, or reveal ultimate truth.
11. I would still consider the experience acceptable even if it is emotionally difficult, confusing, or not enjoyable.
12. I understand that psychedelics can increase anxiety, sadness, or uncertainty instead of reducing them.
Section D
Trust, cooperation, and boundary compatibility with the sitter
13. I trust the person who would be tripsitting me to act in my best interest if I become distressed.
14. If confused or emotional, I would be willing to follow simple safety instructions (for example: sit down, breathe, drink water).
15. I am comfortable with the sitter setting boundaries for safety, such as limits on movement, environment, or dose.
Section E
Accountability, self-control, and readiness to postpone
16. I understand that I am responsible for my behavior during the experience.
17. I would be willing to delay or cancel the experience if the sitter expressed serious concerns beforehand.
18. I am not currently in an acute life crisis (such as severe conflict, trauma, or instability) that would likely dominate the experience.
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