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| Name and phone number |
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| Special considerations or anything else you'd like to mention regarding your diet |
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| If you want to provide more detailed information |
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| If you want to provide more detailed information |
| Write "healthy" if you have no issues |
| Pharmaceutical, natural, vitamins, supplements, etc. |
| Just a brief listing of grade level completed, degrees, certificates, etc. |
| List occupations and/or jobs you've had and for how long |
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| Ayahuasca, DMT, mushrooms, LSD, san pedro, peyote, mescaline, ecstasy, etc. |
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| yoga, meditation, qi gong, martial arts, sun gazing, etc. |
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| What instrument(s)? For how long? |
| NOTE: Singing healing songs (icaros) is central to this tradition |
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| click to read the Terms and Conditions |
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