Schedule an Orientation Call

If you're ready to chat, lets get started.
First, let us know a bit about what you're planning and pick a time for us to talk. The goal of this call will be to get to know each other a little bit and to figure out how we can best support you. You should plan to spend about 15 minutes on the phone with us.
Who is this call for?*
- I am filling out this form on behalf of a friend or loved one.
- I am filling out this form on my own behalf.
Apologies, but based on previous experience, I request that people fill out this form on their own behalf and especially that they are familiar with what I am offering. If the person you are contacting me about is unable to fill out this form then I can suggest two options:
1. You can contact me to set up a pre-paid single session for yourself, which can include other family members or supporters. The focus of this call will be on answering any questions and providing effective support for your loved one entering treatment.
2. Refer to the options for ibogaine aftercare I have posted that suggests various inpatient centers that can provide more intensive support post-treatment.
Name*
Email*
Where are you located?*
City Country
What is your preferred mode of contact?*
What number will we reach you at?*
For numbers outside of the US and Canada please select Whatsapp, Telegram, or Signal and include the country code.
What is your Skype username?*
Can we text you at this number?*
- Yes
- No
Do you already have a treatment booked?*
- Yes
- No
What is the name of the clinic/provider?*
When do you arrive at the clinic?*
Background*
Tell us a little bit about yourself, your treatment goals, and what you hope to gain through our sessions.
Service*
Pick a time this week*
The times listed are in PST (Los Angeles). Make sure to convert the time.
January 2020

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January 29, 2020

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January 30, 2020

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January 31, 2020

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Is it alright if we contact you by email in the future to let you know about upcoming retreats or other news?
- Yes
Do you want to receive call-in details and reminders about our Life After Ibogaine online / phone group meetings. These are free to attend.
- Yes

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January 2020

January 29, 2020

January 30, 2020

January 31, 2020

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