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 (US or International ) Work With Me 1:1 October 4th | Atlanta October 18th | Dallas October 25th | DMV November 8th | LA December 27th | Houston Name * First Name Last Name Age * MM DD YYYY Email * Phone * (###) ### #### Do you have any current or past medical conditions (heart issues, seizures, asthma, high/low blood pressure, etc. If yes, please specify * Do you currently take any medications or supplements (especially SSRIs, MAOIs, blood pressure meds, or other psychotropics)? If yes, please list them. * Do you have a history of trauma, PTSD, or abuse that you feel may arise during ceremony? * Have you ever experienced psychosis or been diagnosed with a psychotic disorder (e.g., ptsd, bi-polar disorder, schizophrenia)? If yes, please specify. * Do you use any kind of illegal drugs or have you ever used them? If yes, please specify. * Have you used plant or psychedelic medicines before? If so, which and when? * What brings you to this ceremony? (healing, clarity, curiosity, spiritual connection, etc.) * What are you currently moving through in life emotionally or spiritually? * Which medicine(s) are you feeling called to? (Kambo, Bufo, Mushrooms, Unsure) * What type of support feels most helpful for you after ceremony? (integration call, journaling prompts, group integration circle, one-on-one support) * Have you researched the effects and potential risks of the psychedelic substance you are registering for? * Yes No How did you hear about this ceremony * Instagram Facebook Word of Mouth/ Referral Returning Participant Other (please share) 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