Master Plant dieta APPLICATION

Please answer the following questions with as much detail as you are able. Your responses are kept confidential and are intended to enhance your experience.

If, for any reason, through the registration process, we find that this experience is not a fit for you, you will be refunded in full or your investment transferred to another experience with Kerry. Your investment will not be refunded if you withdraw from the registration process or the experience for any reason. Registration confirms that you agree to the terms and conditions of working with Kerry.

Name

First Name

Last Name

Date of Birth

Please include Month, Date, and Year. This is to confirm that you are 18 years of age or older.

Phone

(###)

###

####

What is your mailing address?

Kerry may send you a handwritten card or a gift in the mail. If you’re a yes to receiving mail correspondences, please share your address below. If you are a no to this, please type “N/A”.

What about a Master Plant Dieta speaks to you?

What main limitations, obstacles, or edges are you currently experiencing in your life and/or relationships?

What three shifts are you most yearning to create in your life and/or relationships as a result of your work in this dieta experience? How do you envision yourself one year from now?

Do you have a regular spiritual practice such as meditation, prayer, nature, dance, etc.?

Do you have a plants or fungi in mind that you’d like to diet?

Do you have a date or a timeframe of when you’d like to start your dieta?

MENSTRUATION: Where are you in your menstrual journey and what phase of your menstrual cycle will you be in at the opening of your dieta?

If you’re unsure sure of where exactly you’ll be when your dieta begins, a rough guess is good. Also, if you no longer bleed, please share where you imagine yourself to be in your moon phase.

TRAUMA HISTORY: Please share any past or current traumas and/or mental health issues that you've experienced in your life.

Please note that this question will support Kerry in holding space for you.

MEDICAL HISTORY: Do you have any medical conditions, have you undergone any surgeries, or had any body parts or organs removed?

MEDICATIONS & SUPPLEMENTS: Are you currently taking any medications or supplements?

Please share ALL medications and supplements you are taking and please share which ones you are unable to stop during your dieta experience. Please note any birth control.

PREGNANCY: Are you pregnant or trying to conceive? Is there a possibility you could be pregnant during your dieta?

ALLERGIES: Do you have any food, plant, fungi allergies or sensitivities?

Please list all that apply.

ALCOHOL: It is highly important that alcohol be avoided just before, during, and just after your dieta process, along with cannabis and other mind altering substances. Are you able to refrain from alcohol during the duration of your dieta?

PLANT MEDICINES: Do you have any intentions of working with any psychedelic plants during your dieta such as Ayahausca, Mushrooms, Bufo, Kambo, Peyote, San Pedro, etc?

DIETA CALLS: Your dieta experience includes four 35 minute integration calls. One before your dieta opens, two during, and one after your dieta closes. Are you able to show up for all of these calls?

If you wish to extend your Dieta or add more calls, additional options are available for an added investment. Each additional 35 minute call is $111.

I am committed to and able to attend all calls

I am unable to commit to and attend all calls

I already know I’d like additional calls

CANCELLATION POLICY

All payments are non-refundable. Your investment will not be refunded if you withdraw from the registration process or the dieta for any reason. If, through the registration process, we find that this experience is not a fit for you, you will be refunded in full or your investment transferred to another experience with Kerry. If we do so, you will be refunded in full.

I understand the cancellation policy

Are you committed to honoring and taking responsibility for your personal experience and what it reveals for you?

How did you learn about Kerry?

Is there anything else you would like Kerry to know about you?

Please note that any important information about your physical wellbeing, emotional state, mental wellness, addictions, blocks, needed support, are highly important to share to ensure a safe healing journey in your dieta. Even if you think it might be irrelevant, please share!

Master Plant dieta APPLICATION

YOU belong here ♡