Name
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First Name
Last Name
Email
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Phone
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Preferred Date
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1. What are your intentions or goals for this trip? (Examples: personal reflection, healing, exploration, creativity, fun, etc.)
How did you hear about us?
IG
Friend
Event
Current Client
2. Have you had previous experiences with psilocybin or other psychedelics? If yes, how were those experiences for you (positive, challenging, neutral)?
3. Are there any specific emotions or thoughts you're currently working through that might come up during the trip?
4. How do you typically manage anxiety or fear? Are there specific techniques or reminders that help you calm down?
5. If you start feeling uncomfortable or overwhelmed, what kind of support would be most helpful? (Examples: verbal reassurance, silence, physical comfort like a blanket or hug, grounding exercises, guiding you to focus on breathing, etc.)
6. Do you have any specific music or sounds that you find particularly soothing? (Feel free to share specific playlists, artists, or preferences, or leave this open for me to choose something calming.)
7. What type of environment do you think would be most comforting for you? (Examples: dim lighting, soft blankets, nature, etc.)
8. Is there anything you definitely want to avoid during the trip? (Examples: certain types of music, bright lights, specific topics, etc.)
9. Do you have any preferences regarding the level of interaction during the trip? (Examples: Would you prefer to be alone at times? Would you like occasional check-ins? Do you want someone sitting quietly by your side?)
10. Do you have any medical conditions or take any medications I should be aware of before the trip?
11. Is there a grounding object, picture, or item you would like to have near you during the trip to help you feel safe? (If yes, please describe it or make sure it’s easily accessible.)
12. Are there any post-trip rituals or activities that would help you process the experience afterward? (Examples: talking it through, journaling, a quiet meal, watching something soothing, etc.)
13. Is there anything else you'd like me to know about supporting you during this trip?
