First Name *

Last Name *

Email *

Phone *

Street Address *

City *

State *

Country *

Postal Code *

Describe your current & past occupations

Describe your experience with plant medicine, if any

Do you intend to practice herbal medicine in some form in future?

In what way has plant medicine (of any level) changed you as a person?

If you take a moment to connect to your deepest longings, what do you wish the world of plant medicine looked like for you?

Describe a moment of feeling in relationship to a plant or a natural environment

Do you have any current meditation or ritual practice?

Are there any barriers to your participation in the retreat (16th-20th July) or the live classes (Thursday nights 6-8pm)?

How do you plan to overcome these barriers?

Are you on any medication?

Please describe any physical or mental illnesses that you are currently struggling with

Do you understand that this course is not accredited by any national body, and although it will give you great depth in your work with plants, is not enough in and of itself to qualify you for practice? *

YES

Are you able to pay the course fees (either monthly or upfront) without putting yourself into financial distress? *

Part of this process is a phone call to meet each other and answer any questions either of us have. What is a good time of the week to call you? *

Thank you for taking the time to complete your enrolment application.
Stephanie will be in touch soon based on your availability preferences.