For The Good Of All

For the Good of All

Intake Questionnaire
Please read the linked articles and answer the following questions.

Hopkins Medical on Bufo

Forbes Article on Bufo

Time Magazine on the Power of Psilocybin-Assisted Healing

What is Kambo

For the safety of all involved, please answer as honestly and transparently as possible. The more transparent you are in your answers, the better we can cater to your specific circumstances. Rest assured that all correspondence between us is completely confidential. Feel free to contact me directly if you have any questions or concerns.
Name*

First NameLast Name
Email Address*
Please let us know the name of the person who referred you to For the Good of All*
Gender Assigned at Birth*

MaleFemale
What is your Age?*
Weight*
Height*
Occupation*
Phone Number*
Please list which city and state you are inquiring about for the ceremony*
Emergency Contact and Phone Number*
Please list any medications you are currently taking, including dosages. Have you ever taken any psychiatric medications in the past? If so, please list them along with how long you took them and why you stopped.*
Are you aware that certain medications may need to be tapered off prior to your ceremony? Please consult with your prescribing doctor to determine the safest protocol for tapering, if applicable.*

YesNo
Please describe your medical history, past and present conditions.*
Please list any allergies you may have.*
What is your experience with psychedelics and plant medicine? Please list what you have worked with in the past in a social or ceremonial setting*
Please check the following boxes if you have or have had a history of any of the following*

Have you ever struggled with depression or been diagnosed with a depressive disorder?Have you ever been diagnosed with a bipolar spectrum disorder (such as Bipolar I, Bipolar II, or Cyclothymia, Borderline PD) or experienced episodes of extreme mood changes, including elevated or depressive states?Have you ever been diagnosed with or experienced symptoms of an anxiety disorder, such as generalized anxiety, panic attacks, or social anxiety?Have you ever been diagnosed with PTSD or feel that past trauma is still impacting your life today?Have you ever been diagnosed with obsessive-compulsive disorder (OCD) or experienced persistent, unwanted thoughts or repetitive behaviors that felt difficult to control?Have you ever been diagnosed with a psychotic disorder (such as schizophrenia, schizoaffective disorder, or brief psychotic episodes), or experienced symptoms like hallucinations, delusions, or disorganized thinking?Have you ever been diagnosed with narcissistic personality disorder or been advised by a mental health professional that you may display traits consistent with NPD?Have you ever been diagnosed with a substance use or addictive disorder (including alcohol, drugs, sex, gambling, or behavioral addictions)?Do any of your immediate family members have a history of mental health conditions? If so, please specify below.Have you ever experienced thoughts of self-harm or suicide? If yes, please provide details.Have you ever been hospitalized for mental health reasons? If yes, please describe the circumstances.Have you ever been involved in situations where you acted out aggressively or violently toward yourself or others?Have you ever been diagnosed with a sleep disorder such as sleep apnea, night terrors, or parasomnias? If so, please describe the diagnosis and any treatment currently in place.Have you ever been diagnosed with an eating disorder (such as anorexia, bulimia, or binge eating disorder) or experienced disordered eating patterns?None of the above
If you selected any of the above, please feel free to share any details you’re comfortable with. This helps us better understand your journey and how to support you.
What are your expectations from this experience? Are there specific goals or outcomes you hope to achieve?*
If you feel comfortable, please share any past traumas, major life events, or emotional experiences that you believe may be relevant to your healing journey. This can include physical, emotional, or psychological experiences that have impacted you. You are welcome to share as much or as little as feels safe and supportive for you. *
What is you current experience with spiritual and/or personal development? List any practices you may have (i.e. meditation, breathwork, journaling, etc)*
Are you interested in sitting with Bufo/5MeO-DMT?*

YesNo
Bufo is a powerful psychedelic substance found in the Sonoran Desert Toad. It is known for its ability to produce intense and profound spiritual experiences, as well as its potential for therapeutic use. Some people have reported using 5-MeO-DMT as a tool for personal, spiritual growth and self-discovery, with the sacrament helping to bring about a greater understanding of the self, one's place in the world, and the interconnectedness of all things. Others have used it to help alleviate symptoms of mental health conditions, such as addiction, depression, anxiety and PTSD.
Are you interested in sitting with Kambo?*

YesNo
Kambo is a traditional medicine from the Amazon rainforest, made from the secretion of the Giant Monkey Frog (Phyllomedusa Bicolor). It is used for various purposes including physical and emotional cleansing, boosting the immune system, reducing inflammation and pain, and treating various health conditions such as depression, anxiety, and addiction. Some people also claim that it can enhance spiritual experiences and improve overall well-being.
Are you interested in a private Psilocybin journey?*

YesNo
Psilocybin can be a transformative experience that offers profound healing. During a guided journey, you are provided a safe and supportive environment. The experience can involve altered states of consciousness, deep introspection, and a sense of connection to something greater than oneself. Studies have shown that psilocybin can help reduce anxiety and depression, increase creativity, and promote feelings of well-being and connectedness. The guided nature of the journey provides a structured and intentional approach to exploring the psychedelic experience, which can lead to meaningful insights and lasting transformation.
Are you interested in a private Full Immersion Ceremony?*

YesNo
A Full Immersion day is a profound journey into self-work and transformation. Starting with breathwork, participants are guided into heightened awareness and clarity. Kambo, a cleansing ritual, purges the body of toxins and blockages. Following a period of rest Bufo/5MeO-DMT can facilitate deep soul liberation and spiritual insight. A light dose of Psilocybin is then used to integrate the day's experiences, promoting personal growth and healing. This holistic approach blends ancient practices with modern knowledge to catalyze profound shifts in consciousness and overall well-being.
Q&A: Preparation, Ceremony & Aftercare

The above Q&A link is specifically for those interested in aToad/5MeO-DMT ceremony.

Please read it at your own pace, and don’t hesitate to reach out with any questions, curiosities, or concerns. This is your journey, and I’m here to support you every step of the way.
I, the signee of this application, take full responsibility for my physical, mental, emotional, spiritual, and financial transactions in the relationship between myself and anyone associated with For The Good Of All.*

I agree
I understand that those affiliated with For The Good Of All are not medical doctors and cannot diagnose, treat, or cure any disease. I should always consult with my medical doctor before making any changes to my prescription medications, diet, lifestyle or exercise program.*

I understand
By typing in your full name here you are agreeing that all of the above information is true and accurate to your knowledge.*
You will be notified when your intake form is approved. A date and time will be scheduled and confirmed once payment is received. You will then get a full detailed email with all of the preparation and other necessary details to be prepared for your ceremony. Preparation and Integration coaches will be available to you if you desire.
Should be Empty:

For the Good of All