Evolving Temple Client Screening Please enable JavaScript in your browser to complete this form. - Step 1 of 9Personal Information: Full Name: *Email: *EmailConfirm EmailLayoutPhone Number: (International Format) *Age: *Gender: *Profession: *Residential Location: *On a regular basis, we keep our community informed about our forthcoming events through our Line and WhatsApp channels. If you wish to stay connected with us and receive timely updates, we would be delighted to include you in these communities. Kindly share your details with us below, and we'll ensure you stay in the loop. Layout (copy)Add me to the Line Community: *Yes.No.For Thai residents and frequent visitors of Thailand as we share our local events on our Line CommunityLine ID: *Add me to the WhatsApp Community: *Yes.No.Our updates about our Global events are shared through our WhatsApp CommunityWhatsApp Number: *Next1. Reflectiveness and Self-Discovery Our psychedelic treatments are designed to enable profound healing and growth by tapping into the magnificence within you. This process requires deep introspection and reflection, exploring your inner self, accessing hidden areas, and finding unseen connections to the universe we live in. How would you describe yourself as a reflective person? *Next2. Development Activities Reflecting on the past year from where you currently stand: What significant personal, professional, and spiritual developmental endeavors have you been engaged with and how are they impacting you? *Additionally, how satisfied are you with your growth during this period? *Next3. Challenges and their Impact on Your Life Understanding the challenges you are currently facing is essential for us to provide the most effective support in enabling you to overcome them. What are some of the challenges you are currently experiencing in life and how persistent are they? *Please describe the emotions, thoughts, behaviors, and energy surrounding these challenges. *Why is it important for you to address these challenges at this very moment in your life? *When you are able to overcome these challenges, if you look at your life from an aerial perspective, how is it meaningful and valuable to you? *Next4. Growth Areas The growth and development in a psychedelic journey is inherent. This pilgrimage of inner self-discovery and seeing the bigger picture of life fosters profound expansion within yourself. What are some of your aspirations for growth and development? *What are your key aspirations in personal evolution? *What are your key aspirations in professional evolution? *What are your key aspirations in spiritual evolution? *Do you have any other expectations or aspirations? *Why is it important for you to address these developmental opportunities at this very moment in your life? *When you are able to fulfill this developmental goal, if you look at your life from an aerial perspective, how is it meaningful and valuable to you? *Next5. Readiness for the Developmental Journey Embarking on a psychedelic treatment journey is an investment in your personal growth, development, and expansion. This experience requires significant time, financial resources, and a commitment to engaging with the necessary activities over several months during the treatment. Here’s what you need to consider: + In understanding the nature of a Psychedelic healing journey, the energy, time and funds you invest towards the treatment is not directly compared against the services you receive but rather an investment in your development. + The initial treatment fee starts at 3,000 USD which includes preparation protocol, three psychedelic ceremonies and integration over six months. An average follow-up treatment fee is about 1,500 USD which includes preparation protocol, two psychedelic ceremonies and integration over three months. + It is crucial you are capable of allocating time for activities such as reflection, meditation, and engaging in one-on-one and group sessions throughout the treatment period to maximize the benefits of the treatments. + You must be able to commit at least 1-2 hours daily (early mornings and evenings are most suitable) for a minimum of 4 days a week once you begin the journey and be available to travel to your preferred country where psychedelics are legally administered. + Currently we deliver Psychedelic Ceremonies in Nepal, The Netherlands and Portugal. Currently we are working with the legalities within Thailand to obtain the necessary licenses to offer these treatments in Thailand. The fee of the treatment varies based on your preferred location of Psychedelic Ceremony. + Each psychedelic ceremony will require you to be fully available for at least 3-5 days in your preferred location. Given these requirements, how would you describe your ability to facilitate the availability of resources such as energy, time, mental space and finances for this developmental journey with full commitment? *Next6. Health and Wellness We would like to ensure your safety during treatments, as certain health conditions may require special precautions. LayoutAre you currently diagnosed with or have experienced any cardiovascular health issues? *Yes, I am.No, I am not.Knowing your mental and emotional health history allows us to tailor our approach to your specific needs. Have you been diagnosed with any mental or emotional health conditions? *Yes, I have.No, I haven't.Identifying past traumas is crucial for creating a supportive and effective treatment plan. Have you experienced any significant traumatic events in your life? *Yes, I have.No, I haven't.Please provide a brief description: *Are you currently on any specific medication? *Yes, I am.No, I am not.Please mention the medication/s and the reasons for taking them. *NextDo you have questions for us? Please let us know, so that we can be well prepared when we meet you.NextThank you for taking the time to reflect and provide these answers. Please submit your answers below, and you will be prompted to set up a free consultation call on the next page. Restassured, one of our practitioners will thoroughly look into your reflections and unique developmental needs, and be well prepared to discuss the way forward with you during the initial consultation. Please note, in case the treatment may not proceed for any reason, the information you submitted will be removed from all our platforms following the Personal Data Protection Act in Thailand. Submit