Thank you for reaching out to The Phoenix Project. Please fill out the following form so we can better understand your needs and provide the appropriate support.

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Have you had any previous experience with plant medicines or holistic healing modalities? If yes, please provide details:

Would you like to try alternative therapies and/or medicines

What type of support are you most interested in receiving? (Check all that apply)

Information and education about my condition

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Emotional support and counseling

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Financial assistance for treatment

Lifestyle and wellness advice

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By submitting this application, you acknowledge that the information provided is accurate and consent to The Phoenix Project using this information to assess your eligibility for support and to provide appropriate assistance.