Personalised Healing Retreat
Flexible Dates
With Maestra Lucila and Maestro Leonardo
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Welcome
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Minimum stay is 7 nights
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Emergency Contact Info
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Please provide a name and number of a trusted family member or friend who we can contact in case of emergency
What are your intentions for joining us at the center?
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Please share with us your intentions for drinking ayahuasca and working with plant medicines.
Do you have any previous experience with ayahuasca or other psychedelic medicines or substances?
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Please tell us about your food allergies or sensitivities (if any) that you have
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Health and Medical Information
Have you been diagnosed with any medical condition(s) or have a history of mental illness?
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If so, please let us know the specifics
Have you taken / will you be taking any medications or supplements in the 3 months prior to attending your retreat? If so, please share all details (when you started / stopped / dose and any other relevant info)
If so, please include the names of the medications / supplements and dosages.
Special Diet
If you have any special dietary requirements, please let us know
Have you experienced adverse or particularly difficult experiences with ayahuasca / other psychoactive substances that you have found hard to integrate?
Is there anything else about your physical or emotional state we should know about?
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Additional questions
How did you hear about us?
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AyaMundo
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Additional Comments or Special Needs
If there is anything else you want us to know, or if you have any special needs or requirements, please let us know
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