Guided Microdosing Program Application
Thank you for your interest in our Guided Microdosing Programs. Please take a moment to fill out the application form below. We'll reply with a personal email within 3 weeks.
Financial Exchange:
6-week guided program: $650 + tax // 3-month immersive program: $1,475 + tax
Name
Email
Date of Birth
.
Month
.
Day
Year
Which program are you interested in?
6-week program
3-month program
What is your intention for applying to this program? What are your primary reasons for seeking support?
Do you have any previous experience with microdosing? Have you worked with any of our practitioners (any modality) in the past?
Have you been diagnosed with any mental or physical health conditions? If yes, please list, and the approximate date you were diagnosed.
Are you currently taking any prescription medications? If yes, please list the name and dosage for each.
Apply
Should be Empty: