Let’s connect on your JourneyReady to start your healing journey? Share a little about yourself, and we’ll connect with you soon. We’re excited to walk this path together! Please select which ceremony you wish to attend * Private Ceremony (Kambo, Bufo, or Psilocybin) April 16th -18th Minneapolis April 19th - Houston| Men Only April 20th - Atlanta May 10th - Nashville July 4th - 6th | Houston Mini Retreat August 1st - 3rd | Atlanta Mini Retreat Name * First Name Last Name Age * MM DD YYYY Email * Phone * (###) ### #### Do you have any chronic medical conditions (e.g., heart disease, diabetes, asthma)? If yes, please specify * Are you currently taking any medications (prescription, over-the-counter, or herbal supplements)? If yes, please list them. * Have you ever been diagnosed with a mental health condition (e.g., depression, anxiety, PTSD, bipolar disorder)? If yes, please specify * Have you ever experienced psychosis or been diagnosed with a psychotic disorder (e.g., schizophrenia)? If yes, please specify. * Have you previously participated in any psychedelic ceremonies or used psychedelic substances? If yes, please describe your experiences. * Do you use any kind of illegal drugs or have you ever used them? If yes, please specify. * Have you researched the effects and potential risks of the psychedelic substance you are registering for? * Yes No Are you willing to follow dietary and lifestyle recommendations before and after the ceremony to ensure the best possible experience? * Yes No Are you comfortable sharing your experiences and feelings during group intergration sessions following the ceremony ? * Yes No Do you have a support system (friends, family, therapist) in place to help you process and integrate your experiences after the ceremony? * Yes No What are your expectations and goals for this experience?
