• Consult Order Form

    For CENTERS, FACILITATORS, GUIDES AND PROVIDERS. Use this form to purchase and begin a Pharmacologic Risk Triage (PRT) consult or Comprehensive Review & Pharmacologic Management (CRPM) consult regarding a participant, client or patient.
  • "Participant" refers to the person receiving, or potentially receiving, psilocybin. This person could also be considered a client or a patient.

     

    INSTRUCTIONS

    Step 1: If you haven't already within the last 12 months, or you're not sure, please fill out this Consult Communication and Consent form, which we require for anyone ordering or receiving a consult on a participant. Then come back here!

    Step 2: Fill out the below information and submit. Note the following:

    If you are the one purchasing this consult, it is best to know the total number of prescriptions and over-the-counter (OTC) products your participant is taking for the review. If you don't know the total number, you may pick the consult type you need with the minimum charge and we will adjust your final charge based on the number of total products reviewed. 

    If you are not purchasing this consult but simply kicking it off for your participant to purchase and complete, you do not need to know the total number of prescriptions and over-the-counter (OTC) products.

     

     

    WE HANDLE THE REST FOR YOU

    When you submit this form, PharmD Consult will send your participant a single form link that includes:

    a) Communication, Consent & Release of Information. The Communication and Consent is nearly identical to the one you sign above. The Release of Information will allow you to conduct and receive a consult on them. It will be helpful to provide your participant with your/organization's name, email and phone for the release. If your participant has already completed these all these materials within the past 12 months, they will be instructed to skip it and we will confirm everything is on file when we receive the Intake information.

    b) Intake information. We will send the participant an intake form for the consultation type you order below. It is best if the participant, or an authorized representative who knows the participant's medical & medication history well, fills out the intake.

    It helps to coordinate with your participant/client to let them know they will receive these forms to fill out as soon as possible. 

    We will inform you of any delays or issues, and when the participant has completed all forms.

    What to expect once your participant completes all forms:

    For PRT Consult: we may follow up with the participant directly for any needed intake clarifications to complete the review. The consult document is typically shared within 2 business days of completed intake and any needed clarifications from the participant. The entire process typically takes between 2-4 business days and can depend on the responsiveness of the participant. 

    For CRPM Consult: we may follow up with the participant directly for any needed intake clarifications to complete the review. Within 3 business days of completed intake and any needed clarifications from the participant, we will review all the information, draft initial recommendations, and share a link to schedule a 30-minute appointment to review and discuss the consult. Being on camera is NOT required. Additional attendees (including the participant) can be invited. Formal documentation of the completed consult will be shared securely within 1-2 business days of the consultation appointment. The entire process typically takes between 3-7 business days and can depend on the responsiveness of the participant and mutual availabilities for consult review. 

     

    If you have any questions, please email info@psychedelicinteraction.com

    Thank you!

     

  • CONSULT DESCRIPTIONS

    Pharmacologic Risk Triage (PRT) Consult: Get an individualized, high-level documented risk assessment for your participant that screens current medications, over-the-counter (OTC) products, and substances for any contraindicated or high-risk interactions or concerns with a planned psilocybin journey. This is an on-paper review only; no live meeting is offered with this consultation. This pharmacologic screening may be helpful to determine if a deeper Comprehensive Review & Pharmacologic Management (CRPM) consult could be beneficial (aka “triage”); however, it is not necessary to get a CRPM.

    Up to 5 medications+OTCs: $100

    Up to 10 medications+OTCs: $150

    Up to 20 total medications+OTCs: $200

    Refer to the full description here.

     

    Comprehensive Review and Pharmacologic Management (CRPM) Consult: Get a complete pharmacologic evaluation and personalized medication management and safety plan in preparation for one's psilocybin journey. For those who want careful guidance and peace of mind. Includes a detailed written report plus a 30-minute live meeting. You may invite an attendee. Being on camera is not required.

    Up to 5 medications+OTCs: $200

    Additional medications/OTCs: $15 each

    Refer to the full description here.

     

  • prevnext( X )
        Pharmacologic Risk Triage (PRT) - includes up to 5 prescriptions + OTCs. Final cost depends on total number of prescriptions + OTCs.An individualized, high-level risk assessment that screens current medications, over-the-counter (OTC) products, and substances for contraindicated or high-risk interactions with a psilocybin journey.
        $100.00
          
        Comprehensive Review and Pharmacologic Management (CRPM) - includes up to 5 prescriptions + OTCs. Final cost depends on prescriptions + OTCs.A full, deep pharmacologic evaluation and individualized medication management and safety plan in preparation for a psilocybin journey. For those who want careful guidance and peace of mind. Includes up to 5 medications/OTCs.
        $200.00
          
        Total
        $0.00

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