Name
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First Name
Last Name
Email
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Phone
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How old are you?
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Where do you live?
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What is your occupation?
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What is the biggest challenge you are currently facing?
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What is the thing you want most?
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Day to day, how's your inner emotional universe? Calm, stormy, rollercoaster, numb, etc.
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Please describe your relationship to your physical health. Self-care routines. Diet & nutrition. Etc.
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Are you currently working through any physical maladies? Bone breaks, surgeries, autoimmune disorders, gut issues, etc?
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Do you take any medications?
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Do you regularly work with any herbal medicines, supplements or plant medicines?
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Are you pregnant or breastfeeding?
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Do you have any current or former medical diagnoses, either physical or psychological?
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Have you previously undertaken a shamanic plant diet? If so, with what plant(s) and with who?
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What plant are you interested in dieting?
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What dates are you interested in dieting?
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