Integrative Shamanism Practitioner Course – Intake Form
Personal information
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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-
Area Code
Phone Number
Date of Birth
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-
Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Place of Birth
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Homebase (country & city)
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Gender
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Female
Male
Non-binary
Transgender
Other
Pronouns
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She/Her
He/Him
They/Them
Other
Social media link (we endure the safety of our group by previously connecting with future participants)
About You
Would you tell us a little bit more about you? How would you describe who you are at this stage of your life? What do you enjoy doing? What are you passionate about, deeply committed to, or standing for?
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What is your current vocation, profession, or main path of service in the world?
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Do you have any spiritual background or tradition? Did you grow up in a spiritual or religious environment? What practices, if any, are part of your life today?
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Your intentions
What motivates you to join this course?
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What draws you toward integrative shamanism and these practices?
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Your Experience
Have you practiced any of these modalities: shamanism, divination, shamanic journeying, psychic practices, breathwork, meditation, voicework, energy work, somatic practices, trauma work, intuitive movement or any other healing or consciousness-based practice?
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Yes
No
If yes, please share which ones, in what way.
Have you experienced any altered states of consciousness through any method? Please describe your experience.
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Yes
No
If yes, please describe your experience.
Your Inner Landscape
Is there anything in your life that feels challenging at the moment?
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What would you like to receive, learn, or transform through this course?
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Are there themes or personal patterns you feel called to work with or understand more deeply?
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Health & Safety
Have you been diagnosed with any psychological, psychiatric, or physical condition?
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Yes
No
If yes, please share anything relevant for us to know in order to support your safety and well-being.
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Are you pregnant or breastfeading?
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Yes
No
If so, how many weeks of pregnancy, or post-partum?
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Do you feel physically able and emotionally comfortable engaging in movement practices?
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Yes
No
If no, please provide details for us to support you in the best way.
Do you currently have a therapist or any ongoing therapeutic support?
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Yes
No
If yes, which kind of therapeutic support?
Are you currently taking any medication?
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Yes
No
If yes, please list each medication, what it is prescribed for, the symptoms it addresses, and how long you have been taking it.
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Your Intention for Service
In which ways do you feel called to be of service in the world?
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Do you have an idea of how you will be integrating what you will learn into your life, work, or relationships?
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Are you ready to commit to a deep transformative journey, to show up fully, to learn, to practice, and to step forward into your path of service?
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Oh yes!
I guess so
No sure
Final reflections
Integration time is so important, especially with this type of work. Can you plan a little bit of time off after the session to integrate, and do nothing but loving yourself?
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Yes
No
Is there anything else you feel is important for us to know?
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Do you have any question for us?
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Submit
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