Name *

First Name

Last Name

Have you previously done shadow work? If so, please elaborate. *

YES

NO

Have you, within the past 5 years, partook in plant medicines or other substances? *

YES

NO

Have you been professionally diagnosed with any mental or physical health? If so, elaborate below *

YES

NO

Are you currently taking prescription medication? If so, list below. *

YES

NO

Are you able to fully commit to the 90 day portal and complete all homework? *

YES

NO

Are you able to be accountable for your own support/care while in this course? If no, please specify. *

YES

NO