Gender: Male
Birth Date: 1996-04-23
Email: cgoen11@gmail.com
Phone: (972) 467-2283
City: Farmersville
State: Texas
How did you discovery Two Birds Church?: Google
Have you attended any Sunday Services, Outreach, or Virtual Services?: Yes. 2 so far.
Emergency Contact Phone: (214) 585-1482
Relationship: Mom
Emergency Contact Phone: (210) 606-8862
Relationship: Wife
Have you ever been hospitalized for mental health reasons?: No
Have you ever had thoughts of harming yourself?: No, never
Have you ever had thoughts of harming others?: No, never
Are you currently in a mental health crisis or acute emotional distress?: No
Have you ever served in the military?: No
Have you done a Ceremony before?: No
Do you have any experience with other plant sacraments?: Na
What is bringing you to ceremony at this specific time in your life?: Na
Please tell us a little about your Intention for Ceremony: My intention for Kambo is to push myself physically and spiritually.
Are you currently using any recreational substances?: No
Have you ever had a traumatic brain injury (TBI), concussion, or significant head injury?: No
Are you currently pregnant?: No
Do you have any food allergies we should be aware of when preparing meals?: No.
Are you currently taking any prescription medications, supplements, or recreational drugs.: No, medications or drugs'
Health Conditions: No.