Alma Y Tierra Intake Form
please fill out this intake form regarding your interest in our work and we will be in touch to follow up. thank you!
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Why are you interested in exploring this work?
*
Do you currently work with any alternative therapies and if so, which ones. (i.e. meditation, yoga, breathwork)
*
Have you ever worked with psychedelics or sacred plants?
*
Please Select
Yes
No
Not Sure
If you answered yes to the above question, what specifically have you worked with (please list type) - and - please share the context? (i.e. alone, ceremonially, recreationally)
Submit
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