QUESTIONNAIRE

Share With Intention

01| Personal Information

First name

Last name

Phone

Birthday

Month

Day

Year

Location (City, State / Country)

02| Your Journey

What brings you to the Church of the Sacred Mushroom?

How did you first learn about us?

What do you hope to experience or grow through as part of our community?

03| Your Experience

Do you have experience with sacred mushrooms?

Yes

Prefer not to say

If yes, please share about your experience and what you learned.

Are you currently working with any other plant medicines or participating in any ceremonial practices?

Yes

Prefer not to say

If you would like, please tell us more.

04| Your Values

What do “reverence, respect, and responsibility” mean to you in your own words?

Why do you feel drawn to the Church of the Sacred Mushroom at this point in your life

05| Your Connection to the Church

Is there anything else you would like us to know?