Integration #1 Question Title * 1. Full Name Question Title * 2. Email Question Title * 3. How many weeks have you been on our treatment protocol? 0 12 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 4. What blend are you currently working with? Elevate Expansive Balance Golden Mind Flow Huachuma Amanita Question Title * 5. How many capsules a day have you been taking? 1 2 3 Other (please specify) Question Title * 6. What was your initial intention for beginning our treatment protocol? Question Title * 7. Have you noticed a change in the relationship with your original intention? (check all that apply) Nope Slight change Some change A great deal of change Change for the better Change for the worse Question Title * 8. Are there any uncomfortable experiences that you've had that you'd like us to be aware of? No Yes Please specify Question Title * 9. Are you feeling that there needs to be an adjustment to your current treatment protocol? If so, please describe your thoughts. Nope Yes If yes, please specify: Question Title * 10. Please rate your overall experience thus far Extremely valuable Very valuable Somewhat valuable Not so valuable Not at all valuable Next