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Ayahuasca is very safe but in some cases we have to be careful. If you have any of the issues mentioned below it does not necessarily mean we won’t receive you at the retreat, sometimes it means we will need to adjust accordingly. Please don’t book your flights before you submit the questionnaire and get a confirmation email from us.

1- Full Name

2- Whatsapp Number

3- Email

4- Preferred Name

5- Your Nationality

6- Passport Number (required by transportation company)

7- Starting date of the retreat

8- Do you take any prescription medication?

9- Are you taking any SSRI antidepressants or any other psychoactive medicine (ADHD medicine, anti-anxiety, etc) ?

10- Do you have any cardiovascular issues - present or past?

11- Do you have any blood pressure issues?

12- Do you have any serious problems with your health? if yes please let us know

13- Do you have history of psychosis?

14- Do you or any of your family members have history of schizophrenia?

15- Have you experienced suicidal ideation?

16- What is your date of birth

17- What is your gender?

18- Do you have any food allergies?
YesNo
What Kind of Allergies?

19- Do you have any food restrictions?
Vegan (vegetables, legumes)VegetarianOmnivore (vegetables, legumes, eggs, fish, chicken)
PLEASE MAKE SURE YOU CHOOSE WELL, YOU ARE NOT ABLE TO CHANGE YOUR DIET!

20- How did you find us?

Terms and Conditions

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