Microdosing Journey Application

  • Microdosing Journey Application

    Apply here for the 10 Week One on One Microdosing Program

  • Congratulations on taking the first step to change your story and reclaim your power. The hardest part can be taking this leap, so please take a moment to honor that you're prioritizing yourself!

    Your curiosity and courage to explore a transformational path through microdosing with me is not something I take lightly. It is with great privilege and responsibility that I do this work, which is why this application process is so thorough and critical. My top priorities for our work together are to ensure that safety, integrity, alignment and intention are at the core of everything we do. This is our foundation for creating a space where real change and last transformation emerges, evolves and expands.

    Before getting started throughly review and carefully follow the below instructions. The answers and information you provide will inform the way I meet your physical, mental, emotional, energetic and spiritual needs with the depth and care they require.

    Application Instructions:

    • Set aside roughly 45 minutes of uninterrupted quiet time to complete this form with your full attention and presence. If you can, take 5-10 minutes of quiet time before starting.
    • Answer the questions honestly and to the best of your ability. This information is held in complete and indefinite confidentiality.
    • If you don't know how to answer a question please state that, vulnerability is appreciated.
    • Please be as thorough as possible.

    This applications primary function is to evaluate if you are an aligned candidate for this highly personalized program. If for any reason you are not a fit, you will be given the choice of alternative options with either myself or a trusted referral partner within my extensive network. My promise is that you will not be left empty handed. Community and connection is integral to this work.

    *Your application will be reviewed responded to via email within 48-72 hours. 

  • Personal Information & Program Fit

  • Birthdate*
     - -

  • Medical & Mental Health Safety

  • Do you experience any of the following?*
  • Have you ever been clinically diagnosed with any of the following? (Check all that apply) *
  • Do you have a history of or are you currently experiencing any of the following? (Check all that apply) *
  • Are you currently taking (or have you in the last 6 months) any prescription medication?*
  • Have you previously accessed mental health therapies/services (e.g. psychotherapy, psychiatric services)?*
  • Please indicate if you take or have taken any of the following medication types:*
  • GLP-1 Medications (past or present)*

  • Trauma and Past Experiences

  • Select the box if you experienced any of the following before the age of 18:*
  • If you selected any of the experiences above, do you believe this experience or these experiences have impacted your health or wellbeing?*
  • After the age of 18, have you experienced any of the following traumatic events:*
  • If you selected any of the experiences above, do you believe this experience or these experiences have impacted your health or wellbeing?*

  • Lifestyle & Current Practices

  • Are you pregnant, breastfeeding, or planning to conceive?*
  • Do you regularly use any alcohol, cannabis, caffeine, nicotine, or other substances?*
  • Do you currently have a meditation or mindfulness practice?*

  • Psychedelic History & Intentions

  • Have you previously worked with psychedelics?*
  • In what context have you worked with psychedelics?*

  • Growth & Self-Assessment

  • Which areas are you currently experiencing difficulty or misalignment? (select any that apply)*
  • Top 3 intentions for this program*

  • Support, Readiness & Concerns

  •
  • When faced with unpredictable challenges, intense emotions, discomfort or fear, which of the following ways do you respond? (select all that apply)*
  • Are you currently able to carve time out of your personal and professional life, to dedicate ~4–5 hours/week (sessions + reflection practices) to this process?*

  • Additional Information

  • Agreements & Consent

    • I understand this program offers education, coaching, and harm-reduction support, not medical, therapeutic or psychiatric advice.
    • I understand Rachel is not a mental or medical health professional.
    • I understand Rachel does not provide or supply substances.
    • I confirm my answers are true and accurate to the best of my knowledge.
    • I understand that submission of this application does not guarantee my admission to the program.

  • 📧 Important Next Step:
    To make sure you don’t miss my emails, please add rachel@rachelrappa.com to your contacts or whitelist it in your email provider. Sometimes important messages end up in spam or promotions folders. This ensures you’ll receive your assessment call invite and program details.

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