1:1 Microdosing program application**

1

Name* This field is required.

First Name

Last Name

2

E-mail* This field is required.

3

Phone Number* This field is required.

Area Code

Phone Number

4

Why do you feel called to join the 1:1 Microdosing program?* This field is required.

5

Please share any experience you have with microdosing, or with any other entheogen:* This field is required.

6

How did you hear about us?* This field is required.

8

Please describe your current career / life path:* This field is required.

9

Are you willing to commit to a daily spiritual practice?

10

Are you willing to abstain from alcohol and recreational drugs for the duration of the program?

11

Do you know if you'd like to microdose with the Ayahuasca vine tea, or with the Psilocybin Mushroom mix?

12

Please write anything else that you feel called to share below:

13

Please share some dates that would be ideal for you to begin the program:* This field is required.