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Workshop & Ceremony

Questionnaire 

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Question 1 of 10

Full Name, Date of Birth & Phone Number

Question 2 of 10

Do you have any medical conditions, if so, please be specific. Are you taking any medications?

Question 3 of 10

What is your intention for this workshop and/or ceremony?

Question 4 of 10

What is your consumption of animal products such as meats, dairy & eggs?

A

Once a month

B

More than once a month

C

More than once a week

D

I don’t consume any animal products

Question 5 of 10

Do you have experience with plant medicine teachers such as Ayahuasca, San Pedro, Medicinal Mushrooms, Cannabis and other natural substances for the purposes of healing?

Question 6 of 10

This workshop will deal with a variety of topics that are sensitive, are you open to new ideas regarding health and wellness?

A

Yes

B

No

Question 7 of 10

In the home, there will be others going through this experience with you. Do you agree to be respectful of other’s and their questions/needs during the course of the retreat? 

A

Yes, I agree

Question 8 of 10

For this event, it's recommended that you prepare by abstaining from animal products, alcohol, cigarettes and other substances that would hinder the natural healing process. Are you willing to undergo these recommendations at least one week before?

A

Yes

B

No

Question 9 of 10

Do you agree with our privacy terms, due to the nature of this plant medicine retreat?  By this it means that you are in agreement of the personal cases or private information disclosed during the retreat. This is a contract between you, the other participants and myself, the instructor. 

A

Yes

Question 10 of 10

Because this event contains plant medicines that are not FDA approved, you must agree to take full responsibility for yourself during your experience. Results vary on individual efforts, as stated in the terms of service on this website. 

A

Yes, I agree.

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