Application - Psychedelic — No Filter Therapist

Psychedelic Integration: Beyond The Trip

Application

Hi there! Thank you so much for your interest in Psychedelic Integration. So grateful that you're here. I would love learn more about you, your story, and anything else you'd like to provide.

✨ I'll contact you via email after I receive your application.

First Name

Last Name

Age

Email

Location

What days and times typically work best for your schedule?

Are you comfortable with Telehealth sessions or do you prefer in-person sessions?

What other support systems do you have in place, therapeutic or otherwise?

How can I best support you on your psychedelic integration journey?

Are you currently seeing a therapist, if so, whom? If not, have you previously sought our mental health services before? If so, how long ago?

What are you looking for in our one-on-one sessions? (e.g., support, accountability, deep personal work)

What is your experience with non-ordinary states of consciousness (including, but not limited to: psychedelics, meditation, Breathwork)?

Please list mental health diagnosis’ and medications your currently taking

Is there anything else that I should know to best support you on your psychedelic integration journey?

By filling out this form you agree to the following Terms & Conditions: When seeking psychedelic integration services, please know that no part of our therapeutic work together consists of taking of any psychoactive, plant medicine, or illicit substances during sessions. Most psychedelics are still considered Schedule 1 substances, and therefore, remain illegal outside of research settings. I do not under any circumstances provide, procure, or administer illegal psychedelic substances to clients. Additionally, I do not refer any clients to any “underground” or illegal psychedelic services. I do not recommend or encourage anyone to consume any medicines of unknown origin or quality, for they may have disastrous effects to one’s body, mind, heart, and spirit.