Registration Form

This form marks the beginning of a deeper journey — a space to align your intention with sacred transformation, clarity, and inner healing.

Full Name

Phone Number

What are you hoping to experience or release on this retreat?

Have you worked with Plant Medicine before?

Are you a veteran, service-member, or first-responder?

Do you currently have a support system? (coach, therapist, etc.)

Do you have any medical or mental health conditions we should be aware of?

Are you ready to fully commit to your healing and transformation — mentally, emotionally, and spiritually?

Yes, I'm all in.

I'm close but still working through some fear or uncertainty.

Not yet, I'm still exploring.