Private VIP Immersion Retreat Inquiry
Thank you for your interest in my personalized, immersive healing experiences! I'm excited at the thought of getting to know you more and supporting you along your healing journey. Upon submission, please allow up to 1-2 business days to receive a response. I will reach out to you via your preferred mode of communication. 
Sign in to Google to save your progress. Learn more
First + Last Name: *
What is your email address? *
What is your phone number? *
What is your preferred mode of communication? *
On a scale of 1-5, rate your interest in a plant medicine ceremony: *
No Interest
Extremely Interested
Are you under any professional mental health or therapeutic care? *
What are some experiences/ares that you are most interested in learning more about during our time together? *
Required
What are some themes/areas that you are working through on your healing journey right now? *
Where are you located? *
Do you prefer the retreat to be near your city, Southern California, or elsewhere? *
How many days are you interested in for your retreat? 

Pricing begins at $2222 for an overnight plant medicine experience + 1 session, hosted in San Diego or LA. All experiences include an intention setting call prior to the retreat. Specific pricing is dependent upon location, desired topics/areas of focus, etc. Cost per day lowers for 2 and 3 night experiences. I do accept payment plans! 
 *
Is there anything else that you'd like me to know? Medical concerns/conditions? Or any other relevant information to your healing journey? *
When would you like your private retreat to take place?
Clear selection
How did you find me? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms