Full Name
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Phone Number
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How Did You Hear About Us
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2024 SCHEDULE
December 4 -10 (6 nights)
December 12 -18 (6 nights)
2025 SCHEDULE
January 3-10 (7 nights)
May 12-19 (7 nights)
May 22-29 (7 nights)
June 13-20 (7 nights)
June 23-30 (7 nights)
July 3-10 (7 nights)
August 4-11 (7 nights)
August 14-21 (7 nights)
Do you take any pharmaceutical medications or street drugs?
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yes
no
If "Yes" then please list what types
Length of time using AND quantity
Level of perceived trauma (scale of 1-10)
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How much work have you already done on these traumas? (scale of 1-10)
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Please briefly describe your previous plant medicine experience.
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Do you have a heart or liver condition that you are aware of?
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yes
no
Please tell us a bit about why you are interested in working with Iboga
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