KINGSTON SINGLES MEET UP INTEREST FORM

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If you are interested in attending a future ceremony please provide your information below, and indicate which type of Healing you are interested in.

If you simply have questions, or are curious about plant medicines and would like to know more, please indicate that you would like a 30 minute complimentary phone consultation - with no obligation - so that we can have a brief chat and see if plant medicines are appropriate for you.

I am now offering Advanced Wellness Protocols that merge plant medicines with pharmacutical peptides, and exercise prescription, for Health and Longevity Optimization. When these methodologies are used in combination they provide dramatic and self-govererned health care.
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I AM READY TO PARTICIPATE IN
Group Aya Ceremony with Thiago and Jordana in October
Rape Ceremony with Thiago
Kambo with Jordana
Learn to Serve Rapeh Properly with making rapeh Workshop with Thiago and Jordana
Learn to self-serve rapeh, short workshop with making rapeh
One on One Consult with Thiago
Other
Other
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IM NOT READY YET....
I WOULD LIKE AN INITIAL 30 MINUTE PHONE CONSULTATION
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WHY DO YOU FEEL CALLED TO MEDICINE AT THIS TIME?
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I HAVE PREVIOUS EXPERIENCE WITH THE FOLLOWING MEDICINES* This field is required.
Ayahuasca
Mushrooms
LSD
Ketamine
Bufo or 5MEO
DMT
Iboga
Microdosing of any of the above
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IF YOU ARE YOU ON ANY ANTIDEPRESSENTS, SSRIs or MAO INHIBITORS* This field is required.If so, please indicate which and we will discuss further
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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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