Intake Form: DAY TRIPS 2025 (CO)

We work with a variety of plant medicines at Eden. For DAY TRIPS, we work with Anima Mundi which is a blend that you will only find at Eden. It is both spiritually connecting (entheogen) and heart-opening (metaphorically opens the heart space - empathogen).

Day Trips include:
2 Prep Sessions (Zoom)
1 "Before You Trip" Kit
1 Medicine Ceremony
1 Integration
1 Overnight Accommodation
10% off your next SYNC order
2 Post-Day Trip Integration Sessions (Zoom)
Total Investment: $4444 Group; $6955 Couple; $9399 Private

Private Day Trippers will have 2 Private Prep Sessions with Dr. Stefanie & 2 Private Post-Day Trip Integration Sessions with Dr. Stefanie

Couple's will have 1 Private Prep Session with Dr. Stefanie, 1 Couple's Prep Session with Dr. Stefanie, and 2 Couple's Post-Day Trip Integration Sessions with Dr. Stefanie

Group Day Trippers will have 2 Group Prep Sessions with Dr. Stefanie and 2 Group Post-Day Trip Integration Sessions with Dr. Stefanie (time permitting, you may purchase additonal sessions with Dr. Stefanie if you would also like private sessions)

There is a lot of attention being given to psychedelics right now. Eden continues to be a leader in the space and our experiences fill up quickly. The sooner you submit your Intake Paperwork, the better!

We look forward to welcoming you!

Which Coaching + Day Trip Package are you interested in booking? (mark all that apply)

Group Day Trip Package ($4444)Couple's Day Trip Package ($6955)Private Day Trip Package ($9399)

We are currently booking for a Day Trip on Oct 15, 2025. Are you available for this date?*

YesNo

If you are not available for Oct 15, 2025, please let us know 4-5 dates that work for you for a Private Day Trip:*

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Profession*

Linkedin Profile or other Professional/Career Page. If no career page, please include a link to social media page*

Education*

Age*

Date of Birth*

Date

When was your last physical exam?*

Medical Conditions:*

Current Medications & Supplements:*

If you take any form of hormones (ie: Hormone Replacement Therapy, Testosterone, Steroids, etc), please list what you take:*

Psychological Conditions:*

Check the box if you have experienced any of the following conditions throughout your life:*

Emergency Contact:*

This experience requires you to listen to our guidance and follow our rules. Do you have any issue with this?*

NoYes

Do you have any difficulty with authority and listening to authority figures?*

NoYes

If yes to the question above about authority, please explain:*

Please tell us about your experience with plant medicine. If you have no experience, simply write "No experience" in the box below.*

Your intention with this experience*

How did you learn about The Sacred House of Eden?*

If you have been referred to us, please tell us (by name) who referred you to Eden:

Anything else you feel is important for us to know:

If you have been with us before, when is the last time you joined us for Retreat?

Please upload a copy of your driver's license or other form of ID. We need this for proof of age over 21 years old (JPG or JPEG only)*

We extend HERO RATES to active military, vets, law enforcement, and first responders. Do you have any affiliation to military, government, or law enforcement?*

YesNo

If yes to the question above about affiliations, please explain*

By signing this form, I confirm to The Sacred House of Eden that I am over the age of 25 years, and that I am physically capable of participating in the experiences provided by The Sacred House of Eden. I understand and agree that it is my sole responsibility to consult a physician or other qualified health care provider with regard to my ability to participate in this experience. I further understand that my participation in the experience and all activities during the experience are at my own risk and responsibility.*

I understand that The Sacred House of Eden is not a licensed facilitator, but rather a non-profit Visionary Temple in the state of Colorado that provides bona fide harm reduction and support services used concurrently with the sharing of psychedelic natural plant medicines. I understand that Eden is a safe container that provides beneficial community-based use and healing, coaching, and spiritual guidance*

My Products

Deposit for DAY TRIPTo secure your spot for a DAY TRIP, pay your deposit now. We will reach out to you to set up a Consult Call with Dr. Stefanie. If for any reason we determine this is not a good fit, we will immediately refund your deposit.

$350.00

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Payment Methods

Choose from one of the PayPal options to make your payment.

If you are interested in a Private Day Trip, please indicate your preferred dates here:

DAY TRIPS (1 Ceremony, 1 Integration)