Welcome! I’m happy you’re here and I’m so looking forward to working with you. In order to ensure the greatest amount of safety and support in our work together, please fill out the following form. Your responses are completely confidential. I will be in touch shortly. Thank you!
-Michael

Name

First Name

Last Name

Email

Phone

Country

(###)

###

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Which type of session would you like to schedule?

A single session

30-day intentional microdosing container

Prep & integration support

Do you have a diagnosis of bipolar I, bipolar II, or schizophrenia? If yes, please specify:

5. Do you have a history of mania or psychosis? If year, please share a bit more with me.

6. Do you have a heart condition? If yes, please share more with me.

7. Are you pregnant or breastfeeding? If yes, please specify.

Please share a bit about what you would like to focus on in our work together.

Please tell me your top three date/time options for our session. Be sure to include your time zone:

If you need to cancel or reschedule your session, please provide at least 24 hours notice. If you miss your session without canceling, or cancel with less than 24 hours notice, you will be responsible for the cost of the session. Thank you!

I understand the cancellation policy

I have read and accept Axis mundi's terms and conditions (linked below):

Yes

Please send session payment to confirm your booking. Thank you so much. I look forward to working with you soon!

I will send through Venmo (@michaeliankirsch)

I will send through PayPal - friends & family (axismundiceremony@gmail.com)

Axis Mundi’s Terms & Conditions

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Follow along @axismundiceremony

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