Discover Nirvana

1

Full Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number(Optional)

Please enter a valid phone number.

4

Age* This field is required.

5

What is your preferred language?* This field is required.(English or French)

6

Would you like to integrate microdosing into your plan?* This field is required.

YESNO

7

Have you microdosed before?* This field is required.

Yes, currently

Yes, in the past

No, I'm brand new

8

Describe your past experience (what worked / didn’t work)* This field is required.

9

Describe why you're interested* This field is required.

10

What’s your #1 goal with personalized coaching?* This field is required.(e.g., reduce anxiety, improve focus, boost creativity, emotional balance, other)

11

What secondary benefits would you like to experience?* This field is required.(e.g., better sleep, more energy, improved mood, other)

12

What’s your preferred coaching format?* This field is required.

Written guidance only

Email check-ins

1-on-1 calls

13

How soon would you like to start?* This field is required.

Immediately

Within 1 month

Just curious for now

14

Are you currently taking any medication?* This field is required.

15

Do you have any health conditions you’d like to share?* This field is required.(Disclaimer: This program is educational only and does not replace medical advice)

16

What do you hope to achieve by the end of this program?* This field is required.

17

Our coaching programs vary in depth and duration. Which best describes your current financial state for investing in mentorship?* This field is required.(We believe mentorship should feel both exciting and accessible. This helps us match you with the right level of support)

I’m just starting out and want to explore

I’m ready to invest moderately in my growth

I’m ready to go all-in on transformation

18

Is there anything else you’d like us to know before we match you with a coach?(Optional)

19

Find your coach* This field is required.