DAY TRIPS (CO): Intake Form

We work with a variety of plant medicines at Eden. For Day Trips, we work with either Anima Mundi or Sacred Lily.

For Group DAY TRIPS, we work with Anima Mundi which is a blend that you will only find at Eden. It is both spiritually connecting (entheogen) and heart-opening (empathogen).

For Private Day Trips, you can choose to work with Anima Mundi or Sacred Lily, a heart-opening blend (empathogen) you will only find at Eden.

Additional details about the medicine options and what your experience will look like are shared on your Discovery Call with Dr. Stefanie.

Group Day Trips include:

1 Private Intake & Intention Session with Dr. Stefanie (Zoom)
1 Private Medicine Ceremony
Overnight All-inclusive Accommodations
2 Group Post-Ceremony Integration Sessions with Dr. Stefanie (Zoom)
1 "Before You Trip" Kit
Investment $4200

Private Day Trips include:

1 Private Intake & Intention Session with Dr. Stefanie (Zoom)
1 Private Preparation Session with Dr. Stefanie (Zoom)
1 Private Medicine Ceremony
Overnight All-inclusive Accommodations
2 Post-Ceremony Integration Sessions with Dr. Stefanie (Zoom)
1 "Before You Trip" Kit
Investment $9400

There is a lot of attention being given to psychedelics right now. Eden continues to be a leader in the space and our experiences fill up quickly. The sooner you submit your Intake Paperwork, the better!

We look forward to welcoming you!

Which Coaching + Day Trip Package are you interested in booking? (mark all that apply)

Please list 4-5 preferred dates, including both weekdays and weekend options if possible.

Let us know 4-5 preferred dates:

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Current or most recent profession

Linkedin Profile or other Professional/Career Page. If no career page, please include a link to social media page

Education

Age

Date of Birth

Date

When was your last physical exam?

Medical Conditions:

Current Medications & Supplements:

If you take any form of Hormones (HRT, testosterone, steroids, etc.)List all that apply, or write N/A.

If you take any form of Hormones (HRT, testosterone, steroids, etc.) List all that apply, or write N/A.

Psychological Conditions (write N/A if none):

Check the box if you have experienced any of the following conditions throughout your life:

Emergency Contact:

Ceremony requires trust in the container and in Dr. Stefanie's guidance. Are you comfortable following her lead throughout the experience?

In your life, have you noticed patterns of pushing back against authority or guidance, even when it is offered with care?

Ceremony work is a collaborative container. We hold the framework, set, setting, and integration support. You bring your willingness to engage with what arises. How would you describe your relationship to receiving guidance from a facilitator during deep inner work?

If yes to the question above about authority, please explain:

Tell us about your experience with plant medicine. If you have no experience, write "No experience.

What is your intention for this experience? What are you hoping to meet, learn, or transform? There are no wrong answers (even "I don't know yet" is honest.)

Business owners may be able to write off various parts of the coaching you will receive. Let u know if you own a business or operate as self-employed so we an provide an invoice?

How did you learn about The Sacred House of Eden?

If you selected "Other" above, please specify how you learned about Eden:

If you have been referred to us, please tell us who referred you to Eden, so we may thank them:

Anything else you feel is important for us to know:

If you have been with us before, when is the last time you joined us for Retreat?

We extend HERO RATES to active military, vets, law enforcement, and first responders. Do you have any affiliation to military, government, or law enforcement?

If yes, please briefly share your service background:

Please upload a copy of your driver's license or other form of ID. We need this for proof of age over 25 years old (JPG or JPEG only)

By signing this form, I confirm to The Sacred House of Eden that I am over the age of 21 years, and that I am physically capable of participating in the experiences provided by The Sacred House of Eden. I understand and agree that it is my sole responsibility to consult a physician or other qualified health care provider with regard to my ability to participate in this experience. I further understand that my participation in the experience and all activities during the experience are at my own risk and responsibility.

I have read and agree to the Privacy Policy

By signing this form, I confirm to The Sacred House of Eden that I am over the age of 21 years, and that I am physically capable of participating in the experiences provided by The Sacred House of Eden. I understand and agree that it is my sole responsibility to consult a physician or other qualified health care provider with regard to my ability to participate in this experience. I further understand that my participation in the experience and all activities during the experience are at my own risk and responsibility.

I understand that The Sacred House of Eden is not a licensed facilitator, but rather a non-profit Visionary Temple in the state of Colorado that provides bona fide harm reduction and support services used concurrently with the sharing of psychedelic natural plant medicines. I understand that Eden is a safe container that provides beneficial community-based use and healing, coaching, and spiritual guidance

Deposit for DAY TRIP

To secure your spot for a DAY TRIP, pay your deposit now. We will reach out to you to set up your Intake Call with Dr. Stefanie. If for any reason we determine this is not a good fit, we will immediately refund your deposit.

$550.00

Total

Once payment is received, a member of the Eden Team will reach out within 48 hours to schedule your Private Intake Call with Dr. Stefanie

When was your last physical exam?