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Embodied
Integration
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Embodied Integration
Healing Retreat
June 1-7, 2026
Phoenix, AZ
TIME
IT'S
First name
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Last name
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Email
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Phone
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Birthday
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Month
Day
Year
How did you hear about this retreat?
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What is calling you to the Healing Retreat at this time?
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What are you currently navigating (emotionally, mentally, spiritually, or physically) that you hope to gain clarity, healing or transformation around?
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Have you previously worked with psychedelics, ketamine, or other non-ordinary states? If yes, please share a little about your experience and what you learned.
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What therapeutic or healing modalities have you worked with before?
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Talk therapy
Somatic / body-based therapy
Meditation / mindfulness
Coaching
Breathwork
None
Other
On a scale of 1–5, how ready do you feel to surface and let go of any beliefs and habits that are no longer serving you, even if it might be uncomfortable or challenging?
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1 — Protective / Resistant: I tend to feel that my circumstances or other people are the primary reason things aren’t shifting. I’m not sure I’m ready to look at my own role yet.
2 — Aware but Guarded: I can recognize some patterns in myself, but it still feels easier to focus on what others have done or what has happened to me. Letting go feels threatening.
3 — Willing but Cautious: I’m beginning to see where I may be holding onto narratives that limit me. I’m open to exploring my role, but I may still default to blame or self-protection at times.
4 — Accountable and Engaged: I’m willing to examine my beliefs and habits honestly. Even when discomfort arises, I’m open to taking responsibility for my responses and patterns.
5 — Fully Responsible / Ready to Reclaim Power: I am ready to release any story, identity, or coping strategy that keeps me in a victim role. I’m prepared to take ownership of my growth, even when it’s challenging.
Other
Is there anything else you’d like me to know?
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