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An Important Step in the Process

This questionnaire is an important part of our intake process and helps me understand you more clearly as a whole person - your health, your lifestyle, and your lived experience. The questions that follow are asked with care and intention, and there are no “right” or “wrong” answers.

Please take your time and answer as honestly and openly as you can. Everything you share is treated with confidentiality and respect, and your responses allow me to determine whether this retreat is a safe and supportive fit for you at this point in your journey.

Once you’ve completed the form, I will personally review your responses and be in touch with you soon.

Take a breath, settle in, and begin when you’re ready.

Full Name ·
Email ·
Do you have a physical or mental condition at the moment? ·
Are you actually under treatment of a physician or therapist, and if so, for which reason? ·
Are you taking medication or alternative medication (including painkillers and nose spray) ·
Do you use alcohol or drugs? ·
Do you have high blood pressure or have heart disease? Or in the past? ·
Do you have any experience with plant medicine or any other entheogenic medicine? ·
Please tell me something about your motivation to participate in a retreat? ·
Are there any more details of a physical or emotional condition that could be important for me to know? ·

Ready to Begin Your Journey?

Thank you for your interest in this retreat.

Bookings have now closed for this specific date.

If you would like to join one of my upcoming retreats please select another date, if you have any questions please contact me.