Name

Email Address

Your phone number

Your availability

Will you be using insurance for your appointment? Will you be using insurance for your appointment? Yes No

If yes, please provide insurance information

If no, please note our integration sessions are $125 and offered short term (6-8 sessions). If you want ongoing therapy, please let us know.

Let us know what you’re seeking from these services

As most psychedelics are illegal outside of clinical trials, we are offering psychedelic integration and Ketamine-Assisted Psychotherapy services only. Please specify which service you are interested in.

Are you currently seeing a therapist or have you sought mental health services before?

What other supports do you have, therapeutic or otherwise?

What’s your experience with Non-ordinary states of consciousness (NOSC)~ (psychedelics, meditation, breathwork,etc)?