Panimus Integration

Psychedelic Integration Intake Form

Fields marked with an * are required

Name *

Email Address *

Phone Number *

Birthday

City & State of Residence *

What are your Integration Interests? * What are your Integration Interests? * Microdosing Consultation Pre-Journey Guidance and Preparation Trauma Informed, Somatic Approach, Journey Guidance Medicine Choices Post-journey Guidance and Integration Appropriate Dosage Considerations Other (please describe)

Description of Other Interest

What is your experience with psychedelics? *

Mental Health - Please list all diagnosed psychological, psychiatric, and/or other mental health issues (Ex. depression, ADHD, PTSD, personality disorder, etc.) *

Medications - Please list all prescribed medications. (ex: Adderall, Zoloft, etc.) *

Self-development - Please describe your current spiritual and/or self-development and wellness practices (Ex: meditation, journaling, yoga, prayer, breath-work, etc.).

Limitations - Do you have any physical or mental limitations? (ex. disabled, migraines, etc.)

Additional - Is there anything else you think we should know or that you would like to share with us?

[PI] How did you hear about us?

Psychedelic Integration

Psychedelic integration is the successful assimilation into one’s life of spiritual and psychological insights, emotions, visions, and sensations received during psychedelic journeys for the purpose of healing, growth, and well-being.

Psychedelic Integration is an important part of working with these substances in a healing capacity.

Please fill out this intake form to start the process.

Contact me with any specific questions or concerns.

eMail: paul@panimus.net