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

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

Yes

No

Room preferences *

$1900 | Shared room

$2600 | Private room

Collaborator / Staff | Limited spots, contact to inquire rate

*

Arrival Sunday night?

Yes

No