INCIDENT REPORT: The Council
This form is for individuals who have experienced or witnessed harm in medicine or spiritual spaces—ceremonies, retreats, mentorship relationships, or healing containers—where power dynamics were misused, boundaries were crossed, or something left unresolved. We know it can be difficult to name these experiences. This is not a legal report or a public disclosure. It’s a private submission to the Council, a group of experienced medicine women trained in ritual-based response and accountability. You are not obligated to take any further steps by filling this out. This is simply a first gesture toward being heard, witnessed, and possibly supported in a deeper process.Please share only what feels appropriate for now. You don’t need to make it make sense. You don’t have to name anyone unless you want to.Everything you share will be kept confidential within the Council, unless you ask us to take further action together. We're here to listen and hold this with care.
Name
First Name
Last Name
Email
example@example.com
For Signal/ Whatsapp
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Country Code
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Area Code
Phone Number
When did the incident occur ?
Please share as much as you would like us to know at this point about the person, the context, the medicine and what happened.
How do you think this should be addressed?
What are the ways in which we could potentially support you now?
Is it ok for us to contact you on signal? Do you prefer email?
Submit
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