Plant Medicine Retreat Application Name * First Name Last Name Email * Phone (###) ### #### Let me know where to send you a free copy of my book, Awaken! Address Address 1 Address 2 City State/Province Zip/Postal Code Country What is your birthday? * What is your birth time? Where were you born? What would you like to achieve / what are your intentions with this private one-on-one plant medicine retreat? What are you wanting MORE of in your life right now? On a scale of 1 - 10, how committed are you to your spiritual and healing journey? * When are you most uncomfortable? What are some patterns that keep repeating themselves? What are you most proud of and least proud of? What is your current spiritual practice? (it's okay if you don't have one) Are you experiencing any chronic pains, reoccurring physical ailments, afflicted by any diseases, or have any psychological diagnoses that I need to be aware of? If you answered yes to the last question, please go into more details below: What are you most insecure about? * The more vulnerable you can be the better. If your nervous to share now, we can dive into this more throughly in our call. What are you most confident about? What would you say your Superpower is? * Last question: Name someone successful that you admire and why? What are the qualities you look up to in this person? * Thank you!
