SANSARA WELLNESS RETREATS

Before proceeding, please take a moment to review the information on this page. The following form is meant to provide us with insights into your background, enabling us to tailor your experience and ensure your safety during our sacred healing ceremonies. Please keep in mind that these ceremonies are religious in nature and differ from medical or wellness procedures. Completion of this intake form is necessary before participating in any of our sacred plant medicine ceremonies.

 

If any of the following apply to you, you are not eligible to participate in a sacred healing ceremony:

You are under the age of 21, in your first trimester of pregnancy, you have a history of psychosis and or schizophrenia, have been diagnosed with a personality disorder, current active medicated bipolar disorder, history of seizures or diagnosis of epilepsy, current anorexia and or bulimia, experienced a stroke or embolism, severe asthma or emphysema, a known cardiac illness, uncontrolled high blood pressure, Crohn disease, irritable bowel syndrome, ulcerative colitis, or intestinal ulcers, surgery within the last three months on any part of your digestive system or liver disease.For health and safety reasons you cannot attend a sacred healing ceremony if at the time of the retreat you are taking SSRIs, recreational drugs, have taken any medication or supplements 24 hours prior to the ceremony.

All of your responses are entirely confidential. Please read each question and answer carefully. If you would prefer not to answer a question, please leave it blank.

COMMUNITY GUIDELINES AND RULES

 

1. Respect and Consent: Respect the boundaries, privacy, and personal space of others. Obtain consent before touching or engaging in any physical contact.

2. Confidentiality: Maintain confidentiality regarding personal experiences shared during the ceremony. Do not disclose or discuss the experiences of others without their explicit permission.

3. Non-Judgment: Refrain from judging or criticizing the experiences, beliefs, or emotions of fellow participants. Everyone's journey is unique, and it's important to create a supportive and non-judgmental environment.

4. Safety: Prioritize safety at all times. Follow the instructions provided by the facilitators and guides. If you feel physically or emotionally overwhelmed, seek assistance from the facilitators immediately.

5. Sobriety: Abstain from alcohol, recreational drugs, and any substances that may interfere with the ayahuasca experience. Follow any dietary restrictions or guidelines provided by the retreat organizers.

6. Ceremony Etiquette: Maintain a respectful and quiet atmosphere during the ceremony. Refrain from unnecessary talking, loud noises, or disruptive behavior that may disturb others' experiences.

7. Ceremony Preparation: Follow any pre-ceremony guidelines provided by the retreat organizers, such as avoiding certain foods or medications. Prepare yourself mentally and emotionally for the ceremony, respecting the sacredness of ceremony experience.

8. Integration: Understand that the real work begins after the ceremony. Respect the integration process by allowing yourself time and space to reflect on and integrate your experiences. Seek support and guidance from facilitators or appropriate professionals if needed.

9. Environmental Supervision: Respect the natural surroundings of the retreat center or ceremonial space. Minimize your impact on the environment by disposing of waste properly and following any eco-friendly guidelines provided.

10. Personal Responsibility: Take responsibility for your own well-being and experiences. Understand that participating in a ceremony is a personal choice, and you are responsible for your own decisions and actions.

Please note that these guidelines are general suggestions and may vary depending on the specific retreat center or facilitators. It's always important to familiarize yourself with the rules and guidelines provided by the organizers of the Sacred Plant Medicine retreat you plan to attend.

I affirm that the above statement is accurate to the best of my knowledge. I understand that withholding information relevant to my social or psychological well-being could potentially harm both myself and other participants. I agree to release Sansara wellness retreat,  and their assistants from any liability if I fail to disclose pertinent information. Additionally, I commit to informing Sansara Wellness Retreat promptly of any changes in my physical, mental, or emotional health status.