Apply for Our Upcoming Ayahuasca Retreat
Your responses help us ensure this retreat is aligned, supportive, and safe for everyone involved.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
[ + country code ]
Have you ever worked with Ayahuasca?
Yes
No
List any medications you are currently taking or have taken in the last 6 months.
*
(This includes antidepressants, SSRIs/SNRIs, stimulants, mood stabilizers, blood pressure medications, and anything else.)
Do you have any physical health conditions, heart issues, or other medical concerns?
Do you have any diagnosed mental health conditions or history of psychiatric hospitalization?
Do you use cannabis, psychedelics, alcohol, or other substances regularly?
What is your primary intention for attending this retreat, and why do you feel called to work with the medicine?
*
Is there anything about your current emotional or life situation that you feel is important for us to know?
Are you able to travel to Costa Rica for the retreat dates (July 21–26, 2026)
Yes
No
The investment ranges from $4,500–$6,500 depending on accommodations, are you able to meet this investment?
Yes
No
If accepted, are you prepared to reserve your spot with a $1,000 deposit?
Yes
No
On a scale from 1–10, how aligned do you feel with attending this retreat at this time in your life?
Submit Application
Are you prepared to pay $3,950 - $5,950 (price depends on accommodations)... & payment plans are available.
*
If accepted, are you prepared to reserve your spot with a $1,000 deposit?
*
Should be Empty: