Contact Information
Full Name
Email
Phone
Preferred Pronouns
What draws you to the Journey to Essence 3‑month microdosing container at this time?
Have you microdosed before? If yes, please share your experience.
Do you have any experience with plant medicines, meditation, somatic work, or healing practices? Please share what feels relevant.
Are you currently working with a therapist, coach, or other support system? If so, how does this container fit into your existing support?
Are you currently taking any medications? If yes, please list them.
Do you have any history of mental health concerns (anxiety, depression, PTSD, bipolar, etc.)? If yes, please share what feels important.
Any physical health conditions or considerations I should be aware of?
Are you pregnant, nursing, or planning to become pregnant during the 3‑month journey?
What is your primary intention for microdosing over these three months?
What aspects of your life or inner world are you hoping to support, shift, or strengthen through this journey?
Are there habits, patterns, or beliefs you would like to work with more consciously?
What practices are you most interested in exploring (breathwork, being in your body, intention work, cold water immersion, emotional healing and grief work, etc.)?
Are you able to commit to meeting regularly, following the microdosing protocol, and engaging in the suggested practices?
How do you plan to make space in your life for this journey?
Do you have any concerns about time, energy, or capacity you’d like to discuss?
If you hold space for others, how do you envision microdosing supporting your work or professional path?
Are you interested in exploring how to integrate microdosing into your client offerings?
Is there anything else you feel important to share about your intention, your story, or what you’re hoping to receive from this container?
Submit