JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Psychedelic Practitioner Training
: A Transpersonal & Parapsychological Intensive
Please complete this form to apply for our upcoming training
Sign in to Google
to save your progress.
Learn more
Full Name
Your answer
Email Address
Your answer
Phone Number
Your answer
What state do you live in?
Your answer
What draws you to this training?
Your answer
What do you hope to learn or deepen through this training?
Your answer
What aspects of your personal or professional development are you currently working to integrate?
Your answer
Do you have personal experience with psychedelics?
Yes
No
Prefer not to say
This training includes experiential and group-based learning. Are you comfortable participating in group discussions?
Yes
Somewhat
Prefer minimal participation
Please describe your professional experience, training, and background related to personal development, mental health, coaching, facilitation, therapy, or non-ordinary states of consciousness.
Your answer
Professional Background
Psychiatrist or PMHNP
Psychologist / Therapist / Counselor
Nurse / NP / MD
Coach
Psychedelic Facilitator
Student / In Training
Energy Healer
Bodyworker / Somatic Practitioner
Other:
Experience Level
None (interest in learning)
Personal psychedelic experience only
Informal facilitation experience
Professional psychedelic facilitator
Retreat facilitator
Integration coach
Other:
Please share any personal history, lived experience, or challenges that have shaped your interest in this work. This may include experiences with personal development, mental health, trauma, or non-ordinary states of consciousness. Share only what you feel comfortable disclosing.
Your answer
Are there any personal considerations, sensitivities, or experiences that would be helpful for us to know to support you in this training?
Your answer
Is there anything else you would like us to know about you or your interest in this training?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of florestaretreat.com.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report