Mystical Yoga Farm Plant Medicine Questionnaire (Guatemala) 
Thanks for your interested in participating in our ceremonies. Due to the nature of this work, it's important for us to get to know you a bit, and make sure these ceremonies are a good fit.

Please fill out this form with as much detail as possible and your full honesty.  Due to the nature of the plant medicines we work with, it is important for us to know any medications that you are currently taking or have taken in the past 12 months. It can be dangerous to mix certain medications with these plant medicines, so please answer truthfully. 
This form ensures the security and organization of our work, and all information provided here will remain confidential. Rest assured, nothing here will be published or shared. 

Thank You! Please confirm via Whatsapp at +502-4815-4649
Email *
Name *
Email *
WhatsApp Number *
Please provide your country code
What Plant Medicine Ceremony are you wanting to join us for? *
Required
Which ceremony do you wish to join? (Specifically the date(s)) *
If you are choosing a specific ceremony we have scheduled OR if you have a time frame you will be around the lake and are hoping we have one then.
Previous experience with plant medicine *
Please tell us a little bit about your experience with plant medicine (this can include ceremonial and non-ceremonial usage of medicines and substances). What have you worked with before? Where have you had these experiences? Have you had any adverse side effects?
Medical History *
Let us know if you have any important personal or family medical history that might be relevant. Any preexisting conditions etc
Are you currently taking any prescription medications and/or have you taken any prescription medications in the last 12 months. *
If yes, please share with us what medications they are, and if possible the dosage. If you have stopped taking them, the last time you took this medication.
Do you have a history of psychosis or mental health issues? *
Are you taking any supplements?  *
If yes, please list them here!
What is your intention for joining our ceremony? *
This can be any intention, calling, thoughts, or reasons you feel around sitting in a plant medicine ceremony with us. What is alive in you that has made you want to respond to the call?
How did you hear about the MYF and the ceremony? *
Required
By filling out this questionnaire I promise that 
I am telling the full truth and by choosing to join a Heart Song Ministries Ceremony at the Mystical Yoga Farm, I take full responsibility for my actions and wellbeing and I release the Mystical Yoga Farm, and all of it's affiliates, from any liabilities.

I, by means of this form, confirm that I have read and understood the information above and have answered all the questions fully and honestly, not omitting any information. I declare that I am of legal age and voluntarily request to participate in this Spiritual Work with the Sacred Medicine of Ayahuasca and or Hachuma(San Pedro). I confirm that I accept full responsibility voluntarily. I am fully aware and understand the nature of this Spiritual Work, involving an expanded state of consciousness through the ingestion of the Sacred Medicines, as well as the physical and psychological consequences it may entail. I understand that any information omitted by me may involve risks. I agree with the rules of the ceremony, where it is strictly prohibited to carry, use, or be under the influence of any drugs or alcohol. Lastly, I declare that I am fully aware and agree that all the measures outlined above are for my safety and comfort, and that all the information provided in this form is true.

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I agree to receive email updates on upcoming ceremonies and events at MYF
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