Book SPMI - Medicines of Love

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Hello!

Thank you for considering a 15-minute video call consultation with Medicines of Love to explore Somatic Plant Medicine Integration. We are excited to connect with you virtually and provide support in understanding our approach and how it may align with your needs and intentions.

During this brief but impactful video call consultation, our aim is to create a safe and open space for you to discuss your experiences and intentions. We want to understand your unique journey and explore together how our Somatic Plant Medicine Integration approach can benefit you in integrating the insights and wisdom from past plant medicine experiences into your daily life.

Please rest assured that this video call consultation does not involve the administration of any plant medicines. Instead, it serves as an opportunity for you to learn more about our therapeutic approach and how it can facilitate healing and transformation through thoughtful integration.

We encourage you to complete the following questionnaire before our video call, as it will help us prepare for our discussion and make the most of our time together.

At Medicines of Love, we are committed to providing a nurturing, non-judgmental, and compassionate environment for your personal exploration.

We're looking forward to connecting with you through our video call and supporting you on this empowering journey of self-discovery and growth!

I would like to book a 15 minute consultation

Name

Age

Phone number

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Please take a moment to explain your intention/reason for wanting to participate in the Somatic Plant Medicine Integration? The more detail provided, the better we can support you.

On a scale of 0-5, with 0 being the lowest and 5 being the highest, please indicate your level of: Stress

On a scale of 0-5, with 0 being the lowest and 5 being the highest, please indicate your level of: Anxiety

On a scale of 0-5, with 0 being the lowest and 5 being the highest, please indicate your level of: Support from family/friends/community

Please list any recreational or ceremonial substances you may have consumed in the last 2 months (including alcohol, tobacco, marijuana, LSD, psilocybin, etc.). Include the frequency of use.

Please list any pharmaceutical medications you are currently on. Include dosage and frequency of use. It is important that you share the frequency of use and the dosage.

Please list any supplements you are currently on.

Do you go to therapy or are you in a support group? Please provide any pertinent details.

Do you have any health or medical conditions that have not been shared above?

People with extensive trauma histories or who have experienced significant trauma need special considerations with SPMI Therapy. Is it possible that you fall into this category? (Please note, even if the traumatic event/s happened long ago and/or are not seemingly affecting you today, it is important to discuss this durning your phone consultation)

Do you have any fears or phobias?

Please list past experience with plant/spirit ceremonies, who the facilitator was and where the ceremony took place. (Please include any other ceremony experience such as, Cacao ceremony, Sweat Lodge/Temazcal, Moon Circles etc)

Consent and Liability Waiver

I, hereby acknowledge that I have voluntarily provided the information in this intake form for Somatic Plant Medicine Integration sessions offered by Medicines of Love. I understand that the Somatic Plant Medicine Integration sessions aim to explore personal intentions and experiences in a safe and supportive environment. I recognize that Marko Love is not a certified therapist, and these sessions do not constitute therapy or counseling services. Instead, they are designed to provide support, guidance, and a space for self-exploration.

I hereby release Medicines of Love, its practitioners, facilitators, and staff from any liability, claims, demands, actions, or causes of action arising out of or related to my participation in these Somatic Plant Medicine Integration sessions. I confirm that I am of legal age and fully competent to make my own decisions regarding participation. I have read and understood this waiver and voluntarily consent to engage in the consultation and Somatic Plant Medicine Integration sessions offered by Medicines of Love. I understand that the information provided during the consultation is confidential and will be used for coaching purposes only.

I recognize that coaching is not a substitute for professional medical or psychological advice, and I am encouraged to consult with appropriate healthcare providers regarding any medical or psychological concerns.

By submitting this form electronically, I agree to the terms and conditions stated in this waiver and affirm my commitment to actively participate in the Somatic Plant Medicine Integration process for my own well-being and personal growth.

By checking this box, I acknowledge that I have read and agree to the terms of the waiver.