Intakeform

Will you participate in one of our retreats or weekends? 
Please fill in this form and send it to us by clicking on the Send button. 

This intakeform is obliged for participating in a retreat of the Sacred Voyage. No intake is no admission.  

For which retreat have you registered?:*

Name:*

Address:*

Postal code, City:*

Country:*

(Mobile) Phone number:*

Year of birth:*

Gender::*

E-mail address:*

 

Do you have experience with medicine plants? :*

 yes
 no

If yes which one(s)?:

 

Do you have therapy/treatment by a psychologist, psychiatric doctor or other doctor now or did you have it in the past?:*

 yes
 no

If so, for how long and for what reason?:

 

Do you have problems with your heart, high blood pressure or any other condition we need to know about to guarantee you safety?:*

 yes
 no

If so, please elaborate:

 

Do you use medication now or did you use medication in the past? :*

 yes
 no

If so, for how long, what kind of medication and what for?:

Make sure you check with a pharmacy / doctor if it is allowed to use a MAO inhibitor and let us know.

If you are currently on medication did you check with your physician or pharmacist if your medication can be combined with a MAO-inhibitor? We want to be informed if so or not!:

 I did
 I did not

 

Make sure you have at least 3 weeks in between the Cov%d jab and the retreat (if you choose for it):*

Do you use (sometimes or occasionally) any kind of drugs like XTC, alcohol, marihuana, cocaine or other drugs?:*

 yes
 no

If so, how frequently and which drugs?:

We advise to stop using drugs and psychedelics at least one month before the ceremony.

 

How many years of experience do you have concerning spirituality, personal development, education and so on? Wat is your experience with meditation, dance, breath work and/or bodywork?:

 

Do you have any allergies regarding food or are you on a specific diet? :*

 yes
 no

If so which?:

 

Can you write something about the themes you would like to explore with this retreat? What is your intention regarding the healing process?:*

Did you truthfully filled in this intake form?:*

 Yes

Type code:*

* required field