Winter Solstice Plant Medicine & Breathwork Screening: Individuals 🍄 Waiver
I would love to learn more about you to ensure we can protect your health to the best of our ability during our time together. Your following answers will help me support you.
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Name
Phone Number or Email for me to arrange your Welcome & Prep Call
I prefer to use the Signal app for communications :) I appreciate if you download this app and share your phone number with me.
If this is not possible, please let me know if there's another method that's more suitable for you and your preferred contact details (Facebook, Instagram, Mobile Phone, Email)
What plant medicine interests you the most?
Please share some dates/times in May or June that you're available for a 45min Online Welcome & Prep Call
Do you have experience with this plant medicine 🍄? 
Do you have experience with breathwork? 
Do you have any intentions or goals?
Are there are any memories, stories, or experiences that you believe may surface during your journey?
Do you have a community, therapist, or trusted family/friend you can lean into for support? If so, in an event of an emergency, can I reach out to them? Please share name and relation below:
Do you have any food allergies, prescribed medications, or daily supplements/vitamins? If so - what are they:
How would you describe your general emotions / mood? Are you experiencing anxiety, grief, anger, negative self-talk, etc?
What strategies do you use to manage stressful and emotional situations? What / who do you turn to for support when you’re having a rough day, family / friends etc?
On a scale of 1-10, with 1 (not at all) and 10 (very quickly), how quickly do you feel you can bounce back from stress or overwhelm?
not at all
very quickly
Clear selection
Are there any issues about somatic movement or medicine that you're aware of? For example: triggers with shapes, challenging experience with plant medicine in the past, resistance to movement/meditation, etc…)?
Have you been hospitalized for any reason (psychiatric care, surgery, illness)? If so, please specify...
Have you been incarcerated for any reason? If so, please specify whether you're currently on probation and if you have received therapeutic support since.
This portion of the screening is adapted from the TSQ (C.R. Brewin, et al, 2002) and helps us prepare for potential processing of trauma.

How often do you experience the following (0= never, 5 = very frequently)
Upsetting thoughts or memories about the event(s) that come into your mind against your will.
never
very frequently
Clear selection
Upsetting dreams about the traumatic event
never
very frequently
Clear selection
Acting or feeling as though the event were happening again
never
very frequently
Clear selection
Feeling upset by reminders of the event
never
very frequently
Clear selection
Bodily reactions (such as fast heartbeat, stomach churning)
never
very frequently
Clear selection
Difficulty falling or staying asleep
never
very frequently
Clear selection
Irritability or outbursts of anger
never
very frequently
Clear selection
Difficulty concentrating
never
very frequently
Clear selection
Heightened awareness of potential dangers to yourself and others
never
very frequently
Clear selection
Feeling jumpy or being startled by something unexpected
never
very frequently
Clear selection
Consent
The work that is carried out in the session will focus on personal growth and therapeutic self-work by the participant, possibly aided through the ingestion of plant medicine.

New Zealand foraged Plant Medicine contain psychoactive effects. For thousands of years, the indigenous communities of Mexico and beyond have been using mushrooms in their ceremonies to safeguard the health of both the recipient and the community.

Today, mushrooms are used in many places throughout the world for therapeutic and religio-spiritual purposes and for personal growth. 
Mushrooms are legally protected and regulated in some parts of the World. Please review your local laws and understand the risks. In New Zealand, this may be $1,000 fine or up to 3 months prison if charged with possession/ingestion/supply... there have been less than 100 charges in the last 5 years. This year, a marae in Gisborne received a grant from the NZ Government to cultivate psilocybin for treatment of meth-addiction within their community. Multiple NZ-based universities are conducting ongoing research around psychedelics and psilocybin. NZ Drug Foundation published this article on what's next in NZ regarding psilocybin (https://drugfoundation.org.nz/articles/a-psychedelic-renaissance-whats-next-for-psilocybin-in-aotearoa) We believe this is a signal that incriminating for possession/ingestion is a low priority.

Working with mushrooms is not a substitute for medical, psychiatric or psychotherapeutic treatment, but can complement a therapeutic process and facilitate personal development. If you are currently receiving treatment of any kind and are not sure about whether to participate in a session, check with your therapist first.

The effects produced by mushrooms may include changes in your perception of reality and way of thinking, visions (of abstract motifs or clearly identifiable images and scenarios), heightened emotions, access to detailed memories that you’d thought forgotten, paranormal phenomena, the emergence of fears or difficult emotions, (some of which may be associated with blockages in the body and be causing pain and tension), introspection, and perinatal or transpersonal experiences (in which you may experience your own death and rebirth).

At the physical level, you may experience nausea, vomiting, chills, tingling, ringing in the ears, dizziness, diarrhea, tremors, sweating, ataxia, and, in rare cases, fainting. 

You may not notice visionary effects, if that happens, it does not mean the plant medicine is not having an effect on other levels.
The experience can be more intense with eyes closed, and the best thing you can do in difficult times is to breathe slowly and deeply, flow with music, and have confidence in the process that the plant medicine is taking you through, as well as trust in the person holding the session. 

The plant medicine experience is not linear, but rather it passes through different phases, some more
pleasant, even euphoric, and others can be more difficult. You may temporarily experience the
symptoms of mental health distress, such as suspicion, paranoia, and ‘delusions of reference’ (e.g. believing the whole world is watching you or that something is happening because of or for you). It is quite normal to have several waves of these feelings during the experience, and they tend to pass quickly. They are feelings that we all have at some time or another in our lives, and although they may be uncomfortable, exposing ourselves to them in this helps us to deal with them.

Remember, support is right there if you need it; just call out. (We will share ways on how an individual can ask for support during the ceremony).

Although scientific studies show that in controlled environments plant medicine is relatively safe to ingest for people without serious physical or psychological problems, there are some cases of it having adverse effects. These tend to be acute, such as a panic attack or psychotic episode with depersonalization (ego death), and there are some chronic cases, albeit very rare, in the form of anxiety, depersonalization, delirium or psychosis. The setting, adequate preparation, and integration are key to reducing the risks as much as possible.

Your facilitator is responsible for maintaining the confidentiality of any personal information.
This includes your name and contact information that could identify you. 

If you have questions about the session or your integration process over the coming months, feel free to approach the facilitators. Your participation in the sessions is entirely voluntary and you are free to opt out if you wish before the start of the session. 

However, you must endeavour at all times to follow the instructions of the team and
facilitator so that your safety is not jeopardised. The facilitator’s discretion may be used at any
time to exclude you from participation in the session for any perceived impairment in your
physical or psychological health that risks leading to problems for you during the session, or if
for any other reason you do not meet the requirements for participation.

The person administering the plant medicine knows the ingredients and the strength of the dose and will adjust the dose for each participant on the basis of their experience, sensitivity, health status and needs. You will also have choice in the dosage of the medicine, and can choose to drink a smaller dosage. However, if you want to have a larger dose, you will have to discuss this with the facilitator, and understand that at times, a larger dose can be unhelpful to your healing process.

The facilitators are committed to protecting your physical and emotional security, integrity and privacy throughout the process, and intend to provide you with the support you need during the preparation phase, the session itself and the period afterwards. 

We have an emergency protocol and commit to provide any necessary support should the need arise. The emergency protocol is administering first aid, providing 1:1 somatic regulation, reaching out to your therapist of choice or a supportive family/friend/emergency contact, then calling medical attention if physical symptoms do not cease within 3 hours.
Culture of Care + Solidarity

This space recognizes the impacts and intersectional nature of systemic oppressions including racism, homophobia, transphobia and transmisogyny, ableism, classism, cis-hetero-patriarchy, and other harmful structures that are upheld by white supremacy culture. We are explicitly LGBTTQ2S+ affirming, pro-sex worker, anti-racist, in support of disabled and neurodivergent bodies, and approach each member of this community with a spirit of dignity and mutual humanity. We believe that dismantling systems of oppression is important work that benefits everyone; we all live at intersections, we all benefit and are harmed by oppression in different ways and to different degrees. We seek to build a space that centres the wisdom of lived experience, and holds us all in our mutual humanity. 

Embracing Discomfort
Please recognize that the norms and values of the dominant culture are not always the norms of this space. At times this might feel strange or uncomfortable and we may not understand everything right away. Developing skills to sit with that is part of the work of being here. It might take some time to feel things out and get comfortable – that’s okay. Please give it time, stay curious in your reactions, and be self-responsive in taking time to pause, resource, and check in with yourself as things arise.

Some topics which may arise include decolonising psychedelics, cultural appropriation, trauma-informed care, and psychedelic integration.


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