Peru Retreat

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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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Do you have the app Signal? This is an encrypted messaging app. If you do not have it, please download it so we can communicate.* This field is required.
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How did you find us?* This field is required.
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Have you worked with Ayahuasca before?* This field is required.
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I have read and understand the contraindications for working with Ayahuasca, and these do not apply to me.* This field is required.Including but not limited to: most medications, cardiovascular issues, glaucoma, retinal detachment, severe hypertension, recent surgeries, tuberculosis, epilepsy/convulsions, cerebrovascular accidents, serious liver/gallbladder/kidney/pancreas diseases, certain cases of gastroduodenal ulcer or gastritis or digestive hemorrhage, anyone with difficulty vomiting, serious psychiatric disorders such as bipolar/psychosis/schizophrenia/borderline personality/etc.
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No
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At this time, what is your intention for this retreat? What are you hoping to heal? What vision of yourself are you seeking to step into?* This field is required.
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Is there anything else you would like us to know prior to our call?
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Please share some dates and times in the coming 2 weeks (including your time zone) that you are available for a 20-minute consultation call.* This field is required.
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Thank you! We will be in touch regarding your call. During this call, we will share with you a document that should answer most questions and provides many details. This is also a time for you to ask any questions or address any concerns you have. Thank you for your interest :)
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