top of page

Application & Safety Screening

3_edited.png

A deeply supported private experience with preparation, ceremony and integration.

This experience is offered through an application process to make sure it is appropriate for each individual.

 

Please complete the confidential form below as honestly as possible.

​

Submission of this form does not automatically confirm your place. I will personally review your application before we proceed.

Gemini_Generated_Image_hsspzyhsspzyhssp.png
Desert Sand Texture

While you may have a specific program in mind, we invite you to review our other offerings below. If you feel called to more than one, feel free to select multiple options. Upon reviewing your health screening, we will consult and guide you toward the most aligned journey for your current needs.


Reference Links:

🔗 [MICRODOSING PSILOCIBIN - 30 Days Journey] 🔗 [PLANT MEDICINE PREPARATION & INTEGRATION - 7 hrs]

🔗 [Wachuma Microd♥️sing Journey - 7 Weeks]

Which journey(s) are you drawn to?

1. About You

Birthday
Month
Day
Year

2. Your Intention

3. Previous Healing Work

Have you ever been in therapy, counseling or coaching?
Yes
No
Are you currently working with a therapist, psychologist or psychiatrist?
Yes
No
Have you previously explored somatic work, breathwork, meditation, hypnotherapy or other healing modalities?
Yes
No

4. Previous Psychedelic / Plant Medicine Experience

Have you ever worked with psilocybin/mushrooms or other psychedelics/plant medicines?
Yes
No

5. Mental Health

Please select if you have ever been diagnosed with or experienced:
bottom of page