Intake form

Name *

Email address *

What is your preferred pronoun?

What age group do you belong to?

What are your primary reasons for seeking support?

Please select at least one option.

Healing from trauma

Building community

Personal growth

Addressing self-destructive tendencies

Exploring identity

Have you previously participated in any guided medicine work?

How did you hear about QUICK?

Please select at least one option.

Social media

Word of mouth

Online search

Community event

What specific areas would you like to focus on during your time with QUICK?

Which service or services are you interested in?

Please select at least one option.

Small group psychedelic journey weekends

Intentional Festivals

Integration Support

Additional questions or comments