Contact Information
Do you have a physical or mental illness?
Are you currently being treated by a doctor or therapist? If so, for what?
Do you use medicines and/or alternative medicines? (also nasal spray or painkillers)
Do you have an addiction? (Alcohol/Drugs/Other?)
Do you have experience with entheogenic agents?
Would you like to tell us more about your motivation to participate in a session? what would you like to heal or what insights would you like to get
What is your preferred dates?
I would like to participate in
or I first want information about
Other note
I found you through? Or have I been referred by?