Reawaken Your Magic Application Begin your journey by completing this application. Thank you for your interest in Reawaken Your Magic. name * First Name Last Name email * date of birth * MM DD YYYY are you an Oregon resident? * yes no tell me about yourself: * where do you live? what do you do personally and professionally? what do you love? why are you interested in a psilocybin experience with dr. prill? * do you have past psilocybin, psychedelic or non-ordinary states of consciousness experience? * share your experience tell me about any past or current mental health issues or conditions: * including but not limited to anxiety, depression, PTSD, personality disorder... tell me about any relevant life events, known trauma or difficult circumstances in childhood and adulthood tell me about any experiences or processes that nourish and support you: eg: meditation, breathwork, sound healing, yoga, nature time, inner or self work... please check all conditions below you've been diagnosed with: * bipolar disorder schizophrenia personality disorder (narcissism, borderline, dissociative...) psychosis other do you have suicidal thoughts? yes no have you had a suicidal attempt? yes no what is your family history around mental illness? please list any medications or supplements you are currently taking: what type of psilocybin session are you interested in? solo group unsure is there anything else you'd like to share that isn't mentioned above? Thank you! Dr. Prill will reach out shortly. Feel free to go ahead and book a discovery call to get started with any questions you may have.