File an Adverse Event Report

If you have experienced or witnessed an adverse medical incident related to the ingestion of ibogaine, please fill out the following report, or make sure that the best informed authority is able to submit the requested information.

How is this information used?

The information that you provide here will be used to help ensure that ibogaine’s effects are better understood, and to help develop statistics and safety protocols.

All of the personal information input here will remain confidential, and will only be used to contact you in order to request more specific details, or updates. Details of your case, excluding any personally identifying information, may be used in research, training, or discourse ensuring the safe use of ibogaine. Statistics produced from our database will be made available to researchers, to our members, to public health authorities, or in public campaigns targeted at promoting the safe therapeutic use of ibogaine. For more specific information about how your information is used, and how research is conducted, please refer to our privacy policy or contact us directly.

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