Name *

First Name

Last Name

Phone *

Phone

(###)

###

####

Have you had any experience with psychedelics? *

Yes

No

Have you ever worked with a coach or therapist? *

Yes, I've worked with a therapist

Yes, I've worked with a personal life coach or healer

No

Have you ever done inner work in a group setting? *

(12 step, group therapy/coaching, etc.)

Yes

No

Rate your marriage

Required for couples joining

1

2

3

4

5

Do you have any family history of mental health conditions? *

Yes

No

Have you ever been diagnosed with a mental health disorder or hospitalized in a mental health facility? *

Yes

No

Have you ever experienced suicidal thoughts or ideation, past or present? *

Yes

No

Do you currently take, or have been prescribed medications for any mental health conditions? *

Yes

No

Do you currently work regularly with a therapist or personal life coach? *

Yes

No

Room preferences *

Sliding scale available. If this calls you but finances are tight, reach out. We want you there. Payment plans available at checkout with Affirm

Couple $3400

Individual - shared room: $2,100

Individual private room: $2,600

Two friends together: $1,900 each

Collaborator / Staff | Limited spots, contact to inquire rate