MASTER TREE DIET

APPLICATION

Last Name *

Date of birth

First Name *

Email *

Mailing Address* *

Phone *

Emergency Medical Contact (Name & Phone) *

Based on your conversations with Jordan Mockingbird, which Master Tree will you be dieting? *

Birch

Oak

Metasequoia

Undecided

What is your intention for joining this Master Tree Diet? *

What is the biggest challenge you are currently facing in your life? *

Day to day, how's your inner emotional universe? Calm, stormy, rollercoaster, numb, etc. *

Are you currently working through any physical maladies? Bone breaks, surgeries, autoimmune disorders, gut issues, etc? *

Do you currently take any medications? If so, please list: *

Do you regularly work with any herbal medicines, supplements or plant medicines? Please list. *

Do you have any allergies? *

Are you pregnant or breastfeeding? *

What are your sensitivities and known triggers? Physical, emotional, social *

Briefly summarize your history & experience with shamanic plant medicine. *

Have you dieted any plants or trees before? Which ones & with who? *

What is your most significant critique or suspicion with shamanic culture and the plant medicine community? *

Please describe your current understanding of tree dieting, as fully and thoroughly as you can. *

If there is any fear present about this diet, can you name it? *

What's the biggest edge you've had to overcome to do this diet? *

What excites you about dieting Master Trees with our community? *

Anything else you would like to add or note for our facilitation team to consider?

Which MTD are you applying for?

Choose one or more options