Micro Majik Application Form

Ready for a total human upgrade?

Fill-up the application for the Micro Majik experience below.

Name

Phone Number

Date of Birth

What are your preferred pronouns?

Where do you live?

What is your current chosen occupation?

Are you radically committed, willing and able to invest in your personal growth, healing and conscious expansion at this time?

Why is now the right time for you to join our 9-week microdosing protocol?

What is your experience with spirit medicines such as Bufo, Psilocybin, Ayahuasca, San Pedro (Huachuma)?

What is your current experience with spiritual and/or personal development?

Please breifly describe your medical history, and present conditions. Detail any body aches and pains, PTSD, mental illness, depression, anxiety, childhood trauma, any suspected abuse or anything that is causing you to feel broken.

Are you taking any medications? If yes, please share which ones. If you are currently taking SSRs or MAO , please consult your doctor before starting any microdosing program.

Do you have any allergies?

How did you learn about us?

Do you have access to getting psilocybin microdoses on your own or would you like us to provide the medicine for you?

Which package are you interested in?

I, the signee of this application, take 100% responsibility for my physical, mental, emotional, spiritual, financial, sexual, and ALL ENERGY and transactions in the relationship between myself, and anyone associated with Drea Aguilar and Sam Gibbs Morris.

Form submission[]

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