Name
*
First Name
Last Name
What are your preferred pronouns?
she/her
he/him
they/them
other
Email
*
Where are you located? (City, State)
*
Please state, in a few words, what brings you to KAP treatment now?
*
What are your hopes for this experience? Intentions?
*
Please check all that apply
*
Please check all symptoms and concerns/needs that apply
*
In a few short sentences, please explain what is keeping you from receiving KAP treatments in your area or why you would like to work with us?
*
Will you be traveling by air to get to Fort Collins
*
Yes
No
Unsure
COST DISCLOSURE: Cost is dependent on the tier of program you select and each practitioner's experience — with most series costing between $1,000 — $3,000. This estimate includes medical evaluations, preparation and integration, and medicine sessions. *Please note, this is just an estimate for services and actual costs may be slightly lower or higher.
*
What tier are you interested in perusing during your 3-day Intensive? *
*
Please leave any additional comments, questions, or information that will help you and our staff create the best experience for you.
