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Ceremony Inquiry

If you are interested in joining one of our groups or scheduling a private, please use this form to get in touch.

What is your interest?*
- Group
- Private (including private groups)
Are you willing to communicate with us via Signal?*
We will use Signal to communicate with you about ceremony. Signal is a free and secure messaging app for smartphones available from www.signal.org or any App store.
- Yes, I will be available via Signal
- No, I will not be available via Signal
Phone*
Please let us know the phone number associated with your Signal account so we can get in touch.
Name*
First Last
Email*
Which group are you interested in attending?
Please tell us the weekend you want to attend.
What kind of private are you interested in?
We offer all manner of privates, from one-on-one ceremonies to private groups of up to 10, with both of the master teacher medicines.
How did you hear about us?*
If you were referred by someone, please let us know who referred you. If we referred you to this site, just remind us. We generally will not respond to inquiries that were not the result of a referral or through an existing connection.
What is your age?
To which gender identity to you most identify?*
If you would like to let us know your pronouns, use the space below.
Example: She/her, he/him, they/them
Do you have a menstrual cycle?*
The timing of your menstrual cycle, and/or the nature of any cycle irregularities can be helpful to understand, especially when working with these medicines. We can advise you if you have any questions. We also request that if you are experiencing your bleed, or within a few days, at the time of ceremony that you let us know so that we can advise you.
- Yes
- No
Have you worked with any medicines before?*
Examples: Ayahuasca, Huachuma (San Pedro), Peyote, Psilocybin (Magic Mushrooms), Cannabis, MDMA, LSD, 5-MEO DMT (including Bufo), Mescaline, Ketamine, etc.
- Yes
- No
Which of the following have you worked with?
Check all that apply
- Ayahuasca
- Huachuma (San Pedro)
- Peyote
- Psilocybin (Magic Mushrooms)
- Iboga (and Ibogaine)
- Cannabis
- MDMA (Ecstacy)
- LSD
- 5-MEO DMT (including Bufo)
- Mescaline
- Ketamine
- Rapé (aka Hapeh)
- Other
What other medicines not listed above have you worked with?
Please tell us about your experience(s) working with these medicines?*
Things you may include: when you worked with the medicine; with whom; your experience(s)/impression(s).
Have you ever had an adverse reaction to any medicine?*
- Yes
- No
Please tell us about any adverse reactions you experienced?*
Do you have any medical conditions whether current, recent, or prior?*
Please select “Yes” if you have had any recent surgeries or injuries, cancer, autoimmune conditions, seizures, chronic or acute illnesses and provide an explanation in the space provided after. Also, select “Yes” if you are unsure and please describe your question in detail.
- Yes
- No
Please tell us about your surgeries, injuries, or conditions, even if you are unsure if it would prevent you from participating in ceremony.*
If you are unsure about anything, please describe your concern so we can advise you.
Have you ever experienced the symptoms of or been diagnosed with any of the following?*
The use of diagnostic names does not serve in the work we do with people, so we do not fixate on these diagnoses. We are only using these terms in this questionnaire for simplicity as many people have received these diagnosis from others in the past. This helps us in advising those with whom we work.
- Major Depression
- Dissociative Episode(s)
- PTSD
- Bipolar
- Psychosis
- Schizophrenia
- Generalized Anxiety Disorder (GAD)
- Aggression/Rage (Accompanied by physical acts of violence or threat of violence)
- Panic Attacks
- Cluster B Personality Disorders (Histrionic, Narcissistic, Antisocial, Borderline)
- None of the above
Please explain your experience(s) with the above.*
Have you ever attempted suicide, engaged in self-harm behaviors, or had suicidal ideation?*
- Yes
- No
Please expand on your answer to the above question.*
It is helpful for us to understand any history you have with suicidal ideation, attempts, or self-harm. Please tell us about when these events occurred, or if they are still occurring and any other information you can share so that we can understand your history.
Have you ever taken any medications or drugs to alleviate the symptoms of depression, anxiety, or any other similar symptoms?*
- Yes
- No
Please tell us about the medications your took, or are currently taking for the above symptoms.*
Have you received any vaccines in the prior 6 months or do you intend to receive any prior to ceremony?*
- Yes
- No
Which vaccine did you receive?*
Or, which do you intend to receive.
- Covid-19 (Any of the many variations)
- DTaP
- HPV
- Hepatitis
- Influenza
Please tell us the date of your last dose.
We generally advise people not to attend ceremony within six months of receiving most vaccines. However, we can advise you on the possible interactions so that you may make an informed decision.
Have you experienced any symptoms following receipt of any vaccine, such as the following?*
If you experienced something not listed, please use the “other” box and then provide an explanation.
- Soreness
- Headaches
- Fever
- Cough
- Nasal/Sinus irregularity
- Taste/Smell alterations
- Blood pressure changes
- Blood clotting
- Brain fog or memory loss
- Fatigue
- Menstrual cycle changes (cycle length, heaviness of flow, duration, etc.)
- Miscarriage
- Myocarditis
- More frequent colds/flu-like illnesses than prior to receiving the vaccine
- Other
- None
Please explain in further detail the symptoms you have experienced.*
Have you ever been addicted to any substance?*
- Yes
- No
Please describe your addiction.*
Addiction can include dependency on alcohol, drugs, or other substances. Please be candid in your response. If you were ever a participant in a treatment program, please tell us about the treatment.
What do you do for work?*
Or, if you don’t work, what do you devote your time and energy towards.
Are you currently taking, or will you be taking within a month of the the ceremony, any prescription medications, over the counter medications, herbs, supplements, or other plant medicines?*
- Yes
- No
Please list all prescription, over the counter medications, drugs, herbs, supplements, and/or plant medicines.*
Please note that if you are taking any medication, drug or supplement or herb (legal or illegal) of any type that alters brain chemistry, you must discontinue these sufficiently in advance of the ceremony. Some prescription medications such as SSRIs and other anti-depressants have a very long wash out period and may have to be discontinued 4-8 weeks in advance. Some people also forget that certain supplements like 5-HTP and herbs like St. John’s Wort alter brain chemistry and must be discontinued as well. Failing to discontinue medications while working with plant medicines can result in serious complications up to and including death. Please take this question with the utmost sincerity.
Do you have an intention for ceremony?*
It is not necessary to have one, but if you do and would like to share, it can be helpful.
- Yes
- No
Feel free to tell us about your intention.
Please describe briefly any prior or concurrent self-healing work that you are engaged in or that you engaged in during the past.
For instance, if you have been in therapy please tell us a little about that (such what type of therapies helped or didn’t help), or if you have experiences with yoga, meditation, breath work, dance, or other relevant practices.
Will you commit to the preparation prescribed for ceremony?*
Preparing for ceremony will include eating a modified diet, eliminating certain substances, ceasing the use of certain commercial products and other modifications to one’s lifestyle. Preparation may also include eliminating one’s diet of media, news, social media and other external sources of information. You will be provided with detailed preparation information that includes the above. If you know in advance you will be unable to commit to such preparations, please answer “No” below. If you believe you can, or if you have the inner will to commit to such preparations, please answer “Yes.”
- Yes
- No
If you answered "No" to the previous question, please describe below why you answered the question this way.*
Is there anything else you would like to let us know about?*
- Yes
- No
Feel free to let us know about anything else or ask us any questions.
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