Microdosing Mastermind Program

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Please fill out this application to the best of your ability. All applications will be offered careful consideration. If you are selected, we will reach out to schedule a 15-minute interview to make sure you're a good fit for the program.

Email *

Full Name *

Time Zone *

Phone number (To schedule Interview) *

Date of Birth *

YYYY

How long have you been microdosing? *

Tell me a little more about your microdosing experience. (What have you microdose with? And for how long? And how was your experience?) *

Do you want to cultivate a microdosing practice with Banisteriopsis Caapi (Ayahuasca Vine)? Or another substance? *

Have you ever microdosing with ayahuasca vine before? *

Yes

What is your underlying intentions to Join this Microdosing Microdosing Mastermind Program?

Open creative channels

Become more productive

Procrastinate less

Improve learning capacity/speed

Stabilize mood

Improve mental health

Improve physical health

Improve overall outlook on life (I want to be happier!)

Gaining clarity on the direction of my life

Gaining clarity on how to bring my gifts forth into the world

As a tool for plant medicine integration

A desire to let go of limiting beliefs

Psycho-spiritual/self-development

To tap into flow states and peak performance

To heal from...

To connect with, support and learn from other high-level entrepreneurs, creatives and influencers?

Other:

In your own words, why do you want to join this Mastermind program? *

What is your occupation? What are you currently working on? What have you created in the past? *

Are you employed at an office or do you work from home? *

Do you have any mornings during the week to dedicate to cultivating a morning practice where you don’t have to drive for at least 2-3 hours?

Yes

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What medications are you currently taking? *

Please list any supplements you are currently taking.

Have you ever been treated for a mental health condition? If yes, which ones and are you currently in treatment? *

Do you know of any mental illness on either side of your family? Please elaborate

Have you ever tried to commit suicide? If yes, how long ago? *

Do you have any other medical issues? If yes, please list below. *

Have you been hospitalized for any reason within the last 5 years?

On a scale of 1-10 how high would you say your stress levels are on average lately?

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How do you currently handle stress? Do you feel like you have healthy stress management strategies?

Do you feel fully committed to cultivating a microdosing practice that emphasizes and embodies respect for this sacred plant medicine? *

What do you think are your three most self-empowering beliefs? *

What do you think might be your three most dominant self-limiting beliefs? *

Top 3 specific goals you want to accomplish through this program. *

3 Biggest challenges you are currently facing in your personal life? *

Is there anything else you would like to share with me?

How did you hear about this microdosing mastermind program? *

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