Application for Microdosing Program for Eating Disorder Recovery 
Thank you for taking the time to answer these questions for the Microdosing Program for Eating Disorder Recovery (launch date TBC).  these questions help build the scaffolding of the space we create and journey through together. There are no wrong answers here. Allow your responses to arise from the inside out. This is also an iterative process, meaning that what is shared here is constantly evolving and changing, so no need to hold onto any of the answers that you put down. Please note all of your answers remain confidential. Your response will be considered and a reply will be sent in the coming days. An additional meet and greet call may be set up prior to the commencement of the program. Thank you for hearing the call and for your participation.

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Name (please provide first name and surname) *
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Email *
Address and Time Zone *
Phone Number (Whatsapp/Signal) *
Date of Birth *
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Place of Birth and Time of Birth
How did you hear about this program?
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