Medical & Somatic Response Training for Altered States
Application for Medicine Holders & Space Facilitators
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Location
City
State / Province
Postal / Zip Code
What modalities do you currently facilitate? (Select all that apply)
Please Select
☐ 5-MeO-DMT
☐ Psilocybin
☐ Ayahuasca
☐ MDMA
☐ Kambo
☐ Bufo Alvarius
☐ Breathwork
☐ Sound Healing
☐ Somatic or Energy Work
☐ Other (please describe): _______________________
How long have you been holding space in these modalities? Please share a timeline of your facilitation journey.
How did you come into this work? Describe your path to becoming a spaceholder or medicine guide.
What is your current scope of practice? Where, how often, and with whom are you currently facilitating?
Are you working solo or with a team/co-facilitators? Please describe your setup and role within the container.
Do you offer integration or preparation support as part of your facilitation?
Please Select
☐ Yes
☐ No
☐ Sometimes
Please describe what this support looks like.
Experience with Crisis & Responsibility - Have you ever experienced a medical emergency, psychiatric crisis, or spiritual emergence in one of your containers?
Please Select
☐ Yes
☐ No
If yes, please describe the situation(s) and how you responded.
How do you currently assess medical or psychological readiness before a journey?Do you use an intake form, medical screening, or other tools?
What’s your protocol if a participant enters a non-ordinary or psychotic state during a journey? Please share your approach.
Do you carry emergency supplies or medications when facilitating? If yes, please list them. If not, why?
Have you received any medical, psychological, or trauma-informed training relevant to this work?
Please Select
☐ Yes
☐ No
If yes, please describe or list certifications/trainings.
Self-Inquiry & Growth - What is the most challenging aspect of your practice right now? Please reflect honestly.
What supports you in staying resourced and regulated as a facilitator? (Examples: supervision, therapy, personal practices, mentors)
How do you navigate power dynamics and sexual/energetic boundaries in your work? (What agreements or safeguards are in place?)
What’s your relationship with ethical integrity and accountability in facilitation? Share anything that feels important about how you uphold your values.
What are you seeking support with at this stage of your journey? And what drew you to this application?
Website and Instagram:
Anything else you’d like us to know about you or your path?
How did you hear about this training? Who referred you to The Prepared Guide?
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