What is your name? *

First Name

Last Name

What is your phone number? *

(###)

###

####

When is the soonest I can reach you for a phone call?

California/Pacific Standard Time

Monday 4pm

Monday 5pm

Tuesday 4pm

Tuesday 5pm

Wednesday 4pm

Wednesday 5pm

Thursday 4pm

Thursday 5pm

Which type of session are you interested in exploring with? *

QHHT Hypnotherapy - 5 hours

Psilocybin-Assisted Hypnotherapy - 5 hours

Past Life Regression Therapy - 3 hours

Community Past Life Regression - 3 hours

Still deciding.

How else may I tailor your experience?

Reiki

Tarot Card

Essential Oil

Ritual Incense

Healing Sound

Blue Lotus Tea

On what date would you like to have your session?

You can find available times on the page "DATES".

MM

DD

YYYY

I ask for a deposit of $100. How would you like to send this?

We consider this non-refundable or transferable 72 hours before your appointment.

Venmo

Zelle

Cash

Paypal