Grof Legacy Training Canada Medical Form

General Medical History

Psychological/Psychiatric Status & Trauma History

Your Experience & Perpective

Integration & Support System

This work may lead to profound shifts in your life and it is ideal to have a framework of resources in place ahead of time to support you before, during and after sessions. Having support to help you integrate your experiences can help you get the most benefit from the work.

What friend, loved one, counsellor or other trusted person(s) do you speak with about this work? What are their disposition towards you in pursuing this work?
i.e. speaking with trusted persons, meditation, mindfulness, yoga, art, bodywork, journaling, time in nature, etc.

Contact info


I hereby confirm that I have read

and understood the above information, and have answered all questions completely and honestly, and have not withheld any information. My general health, as far as I am aware, is good.

I understand that by submitting this form, I consent to communications with Grof Legacy Training Canada staff regarding my submission.