Thank you for your interest in psychedelic healing. To provide you with the highest level of care please complete this intake form completely and honestly. If there is a question that feels triggering for you to answer, please feel free to say "decline to answer" and we can discuss it in person during your intake session. All information you submit is confidential. If I need to consult on your case with a colleague, I will first receive your written consent before sharing any of your personal information.
There are inherent risks to engaging in psychedelic healing. We will discuss the potential physiological, psychological, and social/spiritual risks of engaging with psychedelic medicine. If you have preexisting mental health disorders or suspect you may, I encourage those clients to consult with their mental health providers about engaging in this work. Filling out this form indicates you are aware of the risks of participating in this form of healing and that you consent to engage in this work at your own risk.
