By accepting this invitation, this form becomes a meaningful step as you explore a psilocybin journey — an experience designed to support personal clarity, insight, and discovery.

This journey calls for readiness, honesty, and commitment. It also involves legal, medical, and emotional considerations, taken seriously to ensure your safety and the integrity of this work.

Before we continue, please note:

• This service is regulated by the State of Oregon and requires you to meet specific eligibility criteria.

• The process includes a $1150-$1450 financial investment, a mandatory Zoom consultation, and an in-person preparation visit at least 24 hours before your session. This visit offers the opportunity to become familiar with the space where your journey will take place.

• You’ll need to complete state-mandated paperwork (at least 24 hours prior to your session), along with reviewing Preparation Guidelines, both of which will be provided to you as a link in the email you receive after submitting the application below.

• Certain medical conditions and/or medications (such as Lithium) may require us to explore other options or timing to ensure your safety.

Please complete the following application with honesty and presence. Your responses will remain confidential and help in understanding your readiness and eligibility for this experience.

As your Psilocybin Facilitator, I honor your courage and appreciate the care you are bringing to this journey.

With warmth and care,

Karlinne Michele Brodine, BSN, RN
Licensed Psilocybin Facilitator – Oregon