Wild Womban Medicine Retreat 2024
Bienvenidos hermana! Welcome sister!
Thank you for your interest in the retreat. Please fill out this application/questionnaire so I can get to know you better, it is important for me to make sure that you and the other sisters in the container can feel safe and held.
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Email *
Given Name (First, Last) 
as well as your nickname, preferred name, etc.
*
Phone number (for whatsapp communication) *
Where do you call home? *
What is your current occupation, and what are you passionate about?
How did you find out about the retreat?
In the rainforest we live deeply immersed in nature. The walls of our structures are made of wood and mosquito net, so we essentially are always outside. 

 Do you have previous experience living immersed in nature? If so, please explain. 
 Do you feel comfortable living very exposed to the elements, plants, and animals of nature?

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Do you have any previous experience relating with indigenous cultures?

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What is your dietary lifestyle like? Do you have any dietary restrictions or allergies?
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1. Are you willing to participate in a specific diet during the week while drinking ayahuasca?
(On ceremony days we do not have salt, onions, garlic, sugar, spices, oil, etc.) 

2  If you are participating in a master plant dieta, are you willing to participate in an even more limited diet, all of the above restrictions and only having veggies, potatoes, quinoa or rice daily for the allotted days?

(We ask this so there are no wild surprises, it is very important to follow the diet while on master plant dieta or there can be consequences from your plant). 
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During the retreat and in the preparation time period before, it is important to abstain from alcohol, drugs, caffeine, narcotics, and certain medications and supplements. Are you willing to undergo the necessary restrictions and lifestyle changes so you can get the most benefit out of your experience? *
Are you currently taking any type of pharmaceutical, over the counter, or homeopathic medicines or herbal supplements? 
Or anti-depressant medication such as SSRI or MAO inhibitors?
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Do you have any medical conditions, ailments, diseases or disorders we should know about?  (Physically, mentally, emotionally, and spiritually?)

*All personal information is kept confidential*
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Is there anyone in your family with a history of psychiatric disorders?
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Are you pregnant, or is it possible you could be?
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Trauma can be one intense event, multiple events, or even subtle occurrences over time that disrupt your nervous system. 

Have you had any traumas in your life? Please explain what feels safe to share.
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Have you drank ayahuasca before? If yes, about how many times and how was your experience? *
Have you received kambo frog medicine before? If yes, how many times and how was your experience? *
Do you have any previous experiences with other plant/earth medicines, psychedelics, or psychoactive medicines? If so, please share any details you deem important, challenging, or inspiring. *
What is your intention for this journey? 
What transformations do you envision for yourself in your life, yourself, and your relationships?
*
What special skills do you have that may be useful for the group creatively and logistically?  *
Are you ready to make the energetic & financial investment in yourself for the transformational journey of a lifetime?  *
Is there anything else you care to share with us? *
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