PRE-QUALIFICATION INTAKE FORM

What’s calling you into this initiation — and why does now feel like the moment to step in?

What’s your current relationship to your s€xual energy and desires? Are you experiencing shame, addiction, performance anxiety, numbness, or disconnection?

Are you currently watching porn, experiencing ED or PE, using pills to perform, or hiding your deeper desires from partners?

Do you currently have an intentional self-pleasure practice?

What’s the most courageous inner work you’ve done, and what did it reveal to you about yourself?

If accepted into this mentorship, what would you need to release, sacrifice, or restructure to go all in?

What embodiment or spiritual practices, if any, do you currently engage in (i.e. breathwork, meditation, and/or movement)?

Are you aware of any trauma—early childhood, relational, s€xual, or religious—that still impacts you today? If so, have you done any healing work around it, and do you have a relationship with your inner child?

What is your current relationship to psychedelic medicines (if any)? Please list all psychedelics you have worked with and in what capacity.

How have you previously invested in your growth — and what was the outcome?

Full Name

On a scale of 1–10, how ready are you to be called forward, held accountable, and penetrated with unwavering truth?

If you feel deeply aligned on our call, are you prepared to invest multiple four figures in yourself for massive transformation?

Phone Number (for text updates)

IG and/or FB Handle(s)

How did you find me or hear about this initiation?

Do you have a supportive community of brothers or sisters that you are apart of?

Email (to save your contact)

Phone Number (that I can text you on)

Form submission[]

PRE-QUALIFICATION INTAKE FORM

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