Practitioner/Mentor Payment Request Form

This is the place for submitting a request for reimbursement/payment from Ancestral Medicine for mentorship sessions with trainees, leading events for the AM network, and other situational payments. Please fill out the form below to submit a request.

Starting June 1, 2020, Ancestral Medicine will make payments on a rolling basis, on or by the 1st and 15th of each month, via Paypal. Provided you submit this form before or right afterward, you should receive payment on whichever date comes first after the date of service you indicated. We will reach out if we have questions about your request, and you will also receive an email confirmation of your submission.

Payments forĀ  practitioner training support, online course support (with the exception of hourly-tracked hours like for FB groups), and other scheduled contracts will be paid on the timeline provided in those agreements and will occur automatically (no need to fill this out for those situations).

Compensation received by Ancestral Medicine for these services is considered independent contractor income. Any person who is eligible to work in the US and earns $600 or more in contractor income within a calendar year will receive a statement of contractor income from Ancestral Medicine as required by US federal law (1099-MISC) by January 31 of the following year. For those in that category, we will be in touch before the end of the year to request or confirm your tax information.

If you have any questions, please reach out to Seyta at Thanks for your service!