JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
6 Week Plant Medicine Integration Program
I appreciate your interest in the 6 week Plant Medicine Integration program. Please complete the application form below. I will reach out to you by email soon.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Email
*
Your answer
Briefly describe your intentions and reasons for seeking integration support?
*
Your answer
Have you previously worked with psilocybin or any other plant medicines? If yes, please provide a brief overview of your experiences.
*
Your answer
How would you describe your current mental, emotional, and physical well-being?
*
Your answer
Are there any specific challenges, stressors, or areas of difficulty in your life that you believe may impact your integration process?
*
Your answer
Do you have a support system in place to assist you during the integration process?
*
Your answer
Do you have a support system in place to assist you during the integration process?
*
Your answer
Are there individuals in your life whom you would like to involve or inform about your participation in this integration program?
*
Your answer
What are your expectations for this integration program?
*
Your answer
Are there any specific concerns, fears, or uncertainties you have about the integration process or working with psilocybin?
*
Your answer
How committed do you feel to engaging fully in the integration process and implementing the insights gained from psilocybin?
*
Your answer
On a scale of 1 to 10, how ready do you feel to embark on this journey of integration and personal growth?
*
1
2
3
4
5
6
7
8
9
10
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms