Journeys
Driftwood Dome
Results
Herbal Tea
About
Blog
Journey Intake Assessment
*
Indicates required field
Name
*
First
Last
Email
*
Thinking about yourself now vs. post Journey, please describe the outcome you most desire.
*
Tell me about your life.
What three words would you use to describe your life right now?
*
What are some things in your life right now that bring you joy?
*
Tell me a little bit about the people you share time with.
*
What are your greatest achievements / the things you are most proud of?
*
Tell me about yourself.
Thinking of yourself as a whole, what three to five words would you use to describe yourself?
*
What do you love most about yourself?
*
What are some patterns of thoughts or behaviors you currently have that you would like to see change?
*
What do you think may be the cause of these patterns? Are you able to reflect on this to pin-point a feeling (in your emotions or in your body) that arises when you are playing out these patterns?
*
There is no right or wrong answer here. You could list words or feelings that come to mind, or a memory. And if you cannot answer, that is okay too. Just do your best.
Tell me about your health and healing.
In the past five years, what other healing and wellness programs have you done? What help have you received? You could list doctors, programs or even self-help books here.
*
Do you have a psychological diagnosis?
*
Are you currently taking prescribed or over-the-counter pharmaceuticals?
*
Psilocybin has adverse reactions with some medication.
Are you currently regularly taking herbal medication?
*
Psilocybin has adverse reactions with some herbal medication.
I invite you to share some extra information with me.
Birth Date, Time and Location
*
This information is so that I can run your human design and astrology charts. This can be helpful in learning how we can best work together.
Which element resonates with you the most?
*
Earth
Fire
Air
Water
Ether
If you have experienced a notable (strange) dream recently, I invite you to share it with me.
*
Dreams often point to clues that can help with healing and self-growth.
Are there any memories from the past that have been popping up for you lately? Please note them here, however small or irrelevant they may seem.
*
Ecosophy Pledge
The Ecosophy pledge is founded in the Toltec wisdom of the five agreements.
I, Danae Jensen, pledge to be impeccable with my word. I will speak with integrity and courageous honesty. I will remember that nothing anyone else does is about me and that others are living and reacting from their own place of reality. I will not make assumptions but rather, I will ask questions with an open and curious mind. I will listen to others with the intention of understanding, knowing their truth may not be the same as my truth. This pledge is made with the grace of my humanity, imperfectly, but I will do my best.
I invite you to take the Ecosophy Pledge as well.
*
I pledge
Submit
Journeys
Driftwood Dome
Results
Herbal Tea
About
Blog
