RPM Application

Relational Plant Medicine

A P P L I C A T I O N

* Indicates required field

Name *

First

Last

Date of Birth *

Pronouns *

Instagram Handle *

Email *

Phone Number *

Emergency Contact // Name and Number *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

How did you first hear about my work and find out about this course? *

Tell me about your past experience with herbalism and flower essences.
Please note, no past experience is required. *

What do you feel drawn to about herbalism in general and this offering specifically? *

Tell me a little bit about what's going on in your world right now. *

Tell me about some of your goals, dreams, and visions for your life. *

What is your heart's deepest desire? *

Tell me about some of the challenges you are facing. *

What does support look like for you? What words or actions help you to feel most seen and held? *

Describe your learning style. What helps things to "click" for you? *

What are your goals for this immersion and retreat? *

Do you have any specific accessibility needs for the online or in person portion of the offering? *

Do you have any specific sensory needs for the online or in person portion of the offering? *

Do you have any dietary preferences or food allergies? *

Is there anything else you'd like me to know about you?? *

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