Application to participate
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Application to participate

"We are honored by your interest in this sacred work. As you may understand, these ceremonies are profound and require deep focus and intention. This is not merely an opportunity to 'experience ayahuasca' but a transformative journey that demands sincere self-reflection and commitment. To ensure alignment with this path, we invite you to complete the following questionnaire with thoughtful honesty and detail."
"We carefully select participants to foster a harmonious and compatible group, ensuring a safe and meaningful experience for all. Our ceremonies are not intended for treating addiction or addressing severe psychological challenges; rather, they are sacred spaces dedicated to personal growth and profound learning".
There are 21 questions in this survey.
application
Please complete the following short questionnaire in detail and with the truth.
(This question is mandatory)
1 Q00001

Please enter your contact details below.

(This question is mandatory)
2 Q00002
What is your Gender?
(This question is mandatory)
3 Q00003

Which category below includes your age?

(This question is mandatory)
4 Q00004

What is your profession?

(This question is mandatory)
5 Q00005

Have you ever consumed ayahuasca? (This is referring specifically to drinking ayahuasca. Not using using DMT in other forms, such as smoking)

(This question is mandatory)
6 Q00006

How much experience do you have with ayahuasca?

(This question is mandatory)
7 Q00007
If you were recommended to us by a friend then please give his/her name and email address as a reference.
(This question is mandatory)
8 Q00008

Do you currently suffer from or have a family history of any of the following ailments?

(This question is mandatory)
9 Q00009

Do you have, or have you ever had, any mental health problems (e.g. depression, anxiety, panic attacks, eating disorder, bipolar disorder, post traumatic stress disorder, schizophrenia, psychotic episode, etc.)?

(This question is mandatory)
10 Q00010

Is there anyone in your family with a history of psychiatric disorders?

(This question is mandatory)
11 Q00011

Are you currently receiving therapy or attending any kind of support group?

(This question is mandatory)
12 Q00012

Are you taking any prescribed or other medication?

(This question is mandatory)
13 Q00013

Have you been hospitalized in the last 20 years? 

14 G00Q21
Have you been vaccinated in the last eight weeks? If so, please comment.
(This question is mandatory)
15 Q00018

What is the highest level of education you have completed?

(This question is mandatory)
16 Q00015

Have you ever experienced adverse or particularly difficult experiences with ayahuasca that you have found hard to integrate?

(This question is mandatory)
17 Q00016

Do you have children?

(This question is mandatory)
18 Q00017

Do you have a spiritual practice?

(This question is mandatory)
19 Q00019

Do you participate in any Shamanic practices?

(This question is mandatory)
20 Q00014

Is there anything else about your physical or emotional state we should know about?

(This question is mandatory)
21 Q00020

Please describe briefly what your intention is, in wanting to attend an Ayahuasca ceremony?

 
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