Women's KAP Group Interest Form
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
What’s drawing you to this group right now?
*
Have you worked with ketamine or other psychedelic medicines before?
*
Yes, in a therapeutic setting
Yes, on my own
Yes in therapeutic setting and on my own
No, this would be my first time!
Are you currently working with a therapist?
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Yes
No
Not currently, but I have in the past
Are you available for all three dates: preparation (Mon, Nov 30, 6pm), the journey day (Sat, Dec 5, 2–6pm), and an integration session to be scheduled together as a group?
*
Yes
Mostly
Not sure yet
Submit Interest
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