Born Counsellng

Pre-Screen Foundational Training

 

This form is the pre-screening for the Comprehensive Introduction to Foundational Training (Experiential Component) on January 21st through January 24, 2027.  Upon completion of this form, you will be contacted by Lindsey Dunning, PMHNP to set up an evaluation.  

 
This training will consist of:
1.  One medical evaluation to be scheduled with Trauma Healing Journey’s prior to the first preparation group to ensure appropriateness of the experiential portion of the training.  
 
2.  Virtual group preparation session scheduled via zoom on January 15th from 10am-12pm.  This session will help you gain a better understanding of what ketamine is and how it works, what to expect from the training and experiential process, and an opportunity to meet the rest of the group.  Additionally, this will begin a process of creating the container, and a chance to get clearer on your goals and intentions for this process.  This group is required; please let us know if you have any conflicts.
 
3.  One in person experiential training with (1) troche ketamine session and (2) intramuscular injection ketamine medicine sessions (one low dose and one high dose).  This training is from January 21, 2027 through January 24, 2027.  It includes the experiential ketamine journeys along with a refresh of the didactic content, facility fees, and any other programming (immersive guided meditations, other embodiment and expressive activities).  All facilitators are licensed clinicians.  Lunch options will be discussed during the initial zoom call (January 15th) as needs will vary among participants.  Snacks will be provided.
 
4.  One virtual integration session via zoom.  This will help you continue to integrate the thoughts, feelings, sensations, and insights from your ketamine journey and allow for follow-up clinical questions regarding KAP.  This is on February 5, 2027 from 10am-12:00pm.  The group is required.  Please let us know if you have any conflicts.  
 
5. Trauma Healing Journey’s will need their own screening and medical history forms. Trauma Healing Journey’s is contracted separately to help facilitate the medical portion of the training. Their fees are built into the entire cost of the program, however it is required to fill out consents and information for them. Once this is completed, your information will be shared with Trauma Healing Journey’s and they will send you the requirements. 
 
The full cost of this program includes medical evaluation, 1 preparation session, training program, medication and all medical fees, 1 follow-up session and lunch each day.  Payment is due in full to participate in the training.  Please carefully review the payment, cancellations and refund policy below.
 
For questions, please contact:
Jamie Born: jamieb@borncounseling.com

Name(Required)
What is the best way to contact you?(Required)

This retreat is for adults ages 21+. Please confirm you are old enough to participate.(Required)
This training is not appropriate for anyone who has been admitted to a psychiatric hospital within the last year. Please confirm that you have not been hospitalized in the last year.(Required)
Do you have a complex trauma history?(Required)
Do you have a known allergy to Ketamine?(Required)
Do you have any dietary restrictions or food allergies?(Required)
Please confirm you have read and understand the cancellation policy.(Required)
Payment, Cancellation, and Refund Policy: Deposit of $750 of program is due upon registration. Full tuition is due by January 4, 2027 and is non-refundable unless you do not medically qualify for treatment. In the case of not medically qualifying, all but $300 will be refunded to cover the cost of your evaluation. If you pay in full before the program start date but are unable to attend, you will receive a 50% refund if you cancel by January 4, 2027.

Full tuition is due by January 4, 2027