Form for a mail-in sample

⚕ Health information
Gender of the sample donor
Age of the sample donor
Did you already try the substance
Encountered issues after using this substance
Description of the health issues / effects caused by this sample
Used other substances alongside this one
Description of other substances that have been used with combination with the submitted one
How often do you use psychotropic substances
🧪 Sample description
What should this sample contain - please specify
If the sample is a distinct product like tablet, blotter, etc. please describe the design, shape, logos, etc.
📱 Sample origin
What is the source of the sample
When was (approximately) the sample procured by the donor
How much did the substance cost per gram/piece/unit, in EUR
Where (place/city of the party, name of club, festival, ...) was the originally sample procured
🗨 Anything else?
Any other information you feel like adding