Client Intake

 Welcome, love!

Thank you for saying YES to this work. Our time together is going to be powerful!!! To help create the most transformational results possible, I ask that you fill out the questionnaire below as soon as possible.

Intention is everything.

Keep it simple. Know that once you’ve sent this to me, your intention has been SPOKEN and ALL the work that unfolds in this space will be in support of those desires.

I also need some essential information from you to ensure the relevance, safety, and efficacy of the recommendations I make.

Step
One:

Please feel into your intention and the results you want to co-create through this work.

Please include area/country code
City and State/Province/Country
In 24 hour time
Please include full name, phone, email, relationship to you, and country of residence.

Intention

(This can change, but it gives us an idea so we can begin to support your intention as soon as possible.)
Ex. clairvoyance, mediumship, intuitive knowing, divination, shamanic journeying, etc.
Share whatever comes to mind, you can't get this one wrong.
Such as tarot/oracle cards, certain rocks or stones, a favorite herb or plant ally, a specific guide you connect with...

Medical History

The following questions may be painful for you. It is not our intention to relive any traumas/pain you may have lingering or affecting you, but it helps us understand what self-healing modalities we can undertake or prepare for you. This is particularly important for any participation in ceremonial medicine work, which has contra-indications we must consider for your safety.

If you do not feel comfortable describing the associated medical detail, please write how you feel. If you'd prefer to only discuss it over the phone, then please note that in the details field.

Thank you so much for your honesty and understanding.
(Including, but not limited to: history of seizures, heart problems, allergies, asthma, lack of mobility, etc.)
Have you ever had any suicidal thoughts or have you attempted suicide? *
Have you recently sought out any counseling, psychiatric, or energy work?
Have you ever (past or present) suffered from addiction? *
(e.g. food, narcotics, alcohol, shopping, etc.)
Within the past 6-months, have you used any narcotics? *
Have you experienced other visionary medicines or psychedelic drugs? *

The Menagerie Collective LLC Client Agreement

We are so excited you have decided to embark on this journey with us, and it is our goal to guide you through a positive and transformational life experience.

Privacy Note: The information you provide us both here and in session will be kept in strict confidence. Unless required by law or for resolution of any dispute, we will not disclose, sell, or in any form communicate your personal information to a third party.

Disclaimer

Lola and/or Tigre Pickett support people in making positive life changes. S/He does this by offering Shamanic healing, spiritual mentoring, life coaching, other forms of energy work (including Reiki), and sharing information, advice, and instruction.

Neither Lola nor Tigre is a licensed medical practitioner. S/He do not conduct any medical or psychotherapeutic work or diagnoses, rather they offer their clients an earth-based awareness of self and a broad spiritual perspective to aid them in their self-healing and self-empowerment. They make no claim that any of their services will directly heal, cure or otherwise change your current health and situation.

They offer advice and information based exclusively on their perspective, training, and life experiences. They make no promises regarding the accuracy, relevance and quality of the information and the methods used in their work.

By submitting this form, I acknowledge that I have read the above information and know that if I choose to enroll in any program with Lola or Tigre Pickett, work with them whether in person or online, and/or attend their Workshops, I take full responsibility for any life changing effects or consequences that this may or may not have. I also understand that for this work to work, I will do my part in all of the homework, exercises and other tools that Lola and/or Tigre suggest(s) during our work together and I take 100% responsibility for doing so as part of this process.

Enter your full name, first and last, as you have entered it on this form like so: /s/John Doe
Format: MM/DD/YYYY

Step
Two:

Complete your payment below. You can choose to go all in or our 6-month installment plan.

**If you have already purchased Empathology™, please enter the following coupon code, depending on which option you select:

  • For ALL IN plans: ALLINROCKSTAR
  • For the 6 month installment plans: MONTHLYROCKSTAR

Otherwise, you'll be given full access to the program as a part of your package.

1
2
3
Contact
Payment
Delivery
CONTACT INFORMATION
APPLY
ORDER SUMMARY
VIP Coaching w/ Private Retreat
$29,997.00
Total
$29,997.00
Select payment plan
WITH Retreat (All In)
WITH Retreat (6-pay)
Coaching Only (All In)
Coaching Only (6-pay)
NEXT
1
2
3
Contact
Payment
Delivery
CONTACT INFORMATION
APPLY
ORDER SUMMARY
VIP Coaching with Private Retreat (Payment Plan)
$5,197.00
Total
$5,197.00
FUTURE PAYMENTS
After today's payment, this card will be charged
$5,197.00 every month for 5 payments
for VIP Coaching with Private Retreat (Payment Plan)
Select payment plan
WITH Retreat (All In)
WITH Retreat (6-pay)
Coaching Only (All In)
Coaching Only (6-pay)
NEXT
1
2
3
Contact
Payment
Delivery
CONTACT INFORMATION
APPLY
ORDER SUMMARY
VIP Coaching Only - All-In
$24,997.00
Total
$24,997.00
Select payment plan
WITH Retreat (All In)
WITH Retreat (6-pay)
Coaching Only (All In)
Coaching Only (6-pay)
NEXT
1
2
3
Contact
Payment
Delivery
CONTACT INFORMATION
APPLY
ORDER SUMMARY
VIP Coaching - Payment Plan
$4,297.00
Total
$4,297.00
FUTURE PAYMENTS
After today's payment, this card will be charged
$4,297.00 every month for 5 payments
for VIP Coaching - Payment Plan
Select payment plan
WITH Retreat (All In)
WITH Retreat (6-pay)
Coaching Only (All In)
Coaching Only (6-pay)
NEXT