MASTER TREE DIET INTAKE FORM
IRISH OAK // COUNTY CORK // NOV 29 - DEC 7
Last Name
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Date of birth
First Name
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Email
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Mailing Address*
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Phone
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Emergency Medical Contact (Name & Phone)
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What is your intention for joining a Master Tree Diet?
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What is the biggest challenge you are currently facing in your life?
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Day to day, how's your inner emotional universe? Calm, stormy, rollercoaster, numb, etc.
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Are you currently working through any physical maladies? Bone breaks, surgeries, autoimmune disorders, gut issues, etc?
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Do you currently take any medications? If so, please list:
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Do you regularly work with any herbal medicines, supplements or plant medicines? Please list.
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Do you have any allergies?
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Are you pregnant or breastfeeding?
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What are your sensitivities and known triggers? Physical, emotional, social
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Briefly summarize your history & experience with shamanic plant medicine.
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Have you dieted any plants or trees before? Which ones & with who?
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What is your most significant critique or suspicion with shamanic culture and the plant medicine community?
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Please describe your current understanding of tree dieting, as fully and thoroughly as you can.
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If there is any fear present about this diet, can you name it?
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What's the biggest edge you need to overcome to do this diet?
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What most excites you about dieting Oak with our community?
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Anything else you would like to add or note for our facilitation team to consider?
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SUBMIT
