Heroic Hearts Project - Initial Application

Heroic Hearts Process is a veteran-built, community-based model for psychedelic care that focuses on the personal work and support needed for lasting change. Our programs include structured screening, preparation, retreat experiences, integration, and ongoing community support to help veterans process trauma and move forward in their lives.

At this time, HHP Retreat Programs primarily work with ayahuasca and psilocybin.

If you are primarily interested in ibogaine, we encourage you to seek out programs with strong medical screening, clear safety protocols, and robust preparation and integration support.

If you’re open to exploring ayahuasca- or psilocybin-based programs within our model of care, we’d be glad to stay connected and help you determine whether HHP could be a good fit.

Please Note: Applications must be completed by the person intending to go on retreat. For example, a veteran spouse may not submit an application for their veteran. If you are completing this application, you are applying for yourself to be eligible for a retreat program.

Additionally, please do not paste Artificial Intelligence responses into your application. Feel free to use these tools to form your ideas, but at the end of the day, we want to hear from your voice.
What type of applicant are you?
Please update any information that may have changed since your last application was submitted.
Personal Details
mm/dd/yyyy
ex. 123-456-1234

Select all that apply.
Address
Please ensure this address is your current place of residence. If selected for attending a retreat program, Veterans will receive a workbook in preparation for your program. 
Military Service
mm/dd/yyyy
mm/dd/yyyy
e.g. 1.9

Your Veteran's Military Service

Heroic Hearts /Hope Project is not a crisis state organization, however if you are experiencing an immediate threat to yourself or someone else, please call 988+1 to speak with a trained crisis state veteran now. or call 516-260-5868 to speak with a GoRoger.org representative within 15 minutes who can connect you to local next day resources.                                                                                                     
Selecting "crisis state" below will not disqualify you from attending a retreat program. Because psychedelics can have a destabilizing effect, we want to ensure each participant is stable and safe.  
Current State



Please update any information that may have changed since your last application was submitted.
Psychedelic History


5-MeO-DMT


mm/dd/yyyy


mm/dd/yyyy


Ayahuasca


mm/dd/yyyy


mm/dd/yyyy


Iboga/Ibogaine


mm/dd/yyyy


mm/dd/yyyy


Ketamine


mm/dd/yyyy


mm/dd/yyyy


LSD


mm/dd/yyyy


mm/dd/yyyy


MDMA


mm/dd/yyyy


mm/dd/yyyy


Peyote/San Pedro


mm/dd/yyyy


mm/dd/yyyy


Psilocybin


mm/dd/yyyy


mm/dd/yyyy


Please update any information that may have changed since your last application was submitted.
Medical History


Select all that apply. Hold the Command key (Mac) or Control key (PC) to make multiple selections.


Select all that apply
Please update any information that may have changed since your last application was submitted.
Quality of Life Assessment

With 1 being completely satisfied and 7 being extremely unsatisfied, how would you rate your current level of dissatisfaction in each of the following categories:

Functional Impact

With 1 being not at all and 7 being severely, to what degree do each of the following items impact your execution of regular, daily tasks and activities?

Please update any information that may have changed since your last application was submitted.
Intentions & Objectives




Spouse/Partner

Referral Details
Application Confirmations