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Shipibo Masterplant Retreats in Peru
-Questionnaire for Retreat Application-

Thank you for contacting me! I’m happy that you are considering joining the retreat.

Before you can register, I want to have a little check-in with you.

Please read on the website about Ayahuasca, Masterplant Diets/SAMA, the Pre- and Post-Dieta, and the Medical Guidelines.

If you have any concerns, let me know! It is your responsibility to get familiar with our Retreat offer and the requirements.

www.true-journey.net

Please answer the following questions honestly, focusing on the essential and important aspects that are relevant to know. We will have additional time to go deeper into your processes during the preparation calls.

This is just the first step for the Retreat Application. There will be a free 20 min call offered after I read your responses.

It is crucial that you are 100% honest, especially regarding your health. Lack of honesty can create an unsafe environment for all participants, the team, and yourself.

I want to ensure that you find the support you need at the retreat so that we can create a safe setting. Please feel free to reach out with any questions!

This is just a brief check-in to help me understand if we can provide what you are looking for.

All information you share with me will remain 100% confidential.

In case you sign up, I only share information with the True-Journey team so that we can support you as best we can.

Thank you very much for your trust in advance.

One little tip: It may be best to copy your answers into a personal document, just in case there are technical issues with uploading the online form. In that case, not all your writing will be lost.

Name (First/Last)

Age

Gender

Retreat (Date/Length/Location)

Passport Number

Why do you want to come to the Ayahuasca Retreat / Masterplant Dieta? Please describe your personal reason.

Do you bring specific intentions to the retreat?

Do you have serious physical health problems? Or did you have any in the past? Anything going on with your heart? If yes, please describe.

Do you have any known allergies, sensitivities, skin conditions, or unusual reactions to plants, herbs, foods, insect bites, sunlight, or medications? If yes, please describe.

Have you ever experienced a significant physical or psychological reaction during or after a retreat, ceremony, plant medicine experience, fasting period, or traditional healing treatment? If yes, please describe.

Have you had suicidal ideas/thoughts during the last 5 years? Have you ever had suicidal attempts or thoughts in your life? If yes, please describe what happened and how you are feeling right now about it.

Did you ever hurt yourself? Did you ever show self-harming behavior? If yes, please describe it.

Do you use any medication at the moment?

Did you ever take antidepressants? If yes, please describe.

Have you ever had psychosis symptoms? Or been diagnosed with psychosis or any bipolar disorder? If yes, please describe the circumstances.

Has someone in your family had so-called psychosis symptoms or been diagnosed with psychosis or bipolar disorder?

Have you ever been hospitalized for psychiatric reasons?

Have you ever been hospitalized for medical reasons? If yes, please describe.

Did you ever experience any kind of traumatic abuse, violation, or rape? If yes, did you talk about it or have you done any therapy? Please describe.

Do you have a drug addiction at the moment? Have you had one in the past?

Do you consume any kind of drugs on a regular basis? If yes, which ones? Please describe your consumption behavior.

Do you have any other addictive patterns? If yes, please describe.

Have you ever been involved in fights (physically)? If yes, please describe the situations.

Are you practicing any martial arts?

How is your sleeping pattern over the last 6 months? How would you describe it?

How is your living situation? How is your social network? Do you have close friends or family members?

Do you have any previous experience with Ayahuasca or other entheogens? How were your experiences? Please describe your process.

Have you ever done a Masterplant Dieta before? Which plants? In which tradition? What kind of setup? Where and with whom have you done it?

How is your spiritual experience in life? Do you follow any practice? Do you have a certain belief? How is your spiritual view or cosmovision? How do you see Ayahuasca or Masterplants in this context?

Have you done any type of “shadow work” with yourself? What I mean by that is, do you work with hidden parts, emotions, or unconscious energies inside of you? Are you doing any practice to look into your unconscious patterns and parts?

Where do you see your challenges in life? Please describe how they show up and how you respond to them.

Does anything come up that feels important for you and that you want to share with me?

I understand that participation in the retreat is entirely voluntary and based on my own free decision.

Yes

I understand that the retreat, facilitators, and traditional healers do not provide medical, psychiatric, or psychological treatment and that the retreat is not a substitute for professional healthcare.

Yes

I understand that True-Journey and its facilitators rely on the information provided by me when assessing my suitability for participation.

Yes

I understand that submitting this questionnaire does not guarantee acceptance into the retreat and that True-Journey reserves the right to decline participation if concerns regarding safety, health, or suitability arise.

Yes

I understand that traditional plant medicine practices may involve physical, emotional, psychological, and spiritual experiences that can vary significantly from person to person and that individual responses cannot be predicted with certainty.

Yes

I confirm that all information provided in this questionnaire is complete, truthful, and accurate to the best of my knowledge.

Yes

I understand that withholding relevant medical, psychological, psychiatric, or substance-use information may increase risks to myself and others and may result in my participation being declined or terminated.

Yes

34.IMPORTANT NOTICE

This questionnaire is intended to assist in assessing suitability for participation and

does not replace the Retreat Agreement, Disclaimer, Medical Guidelines, informed

consent documents, or any additional documentation required by True-Journey.

The information provided in this questionnaire will be treated confidentially and

used solely for the purpose of assessing suitability, preparation, safety, and

participation in the retreat.

Thank you very much for your trust!!

Please wait with transferring any money until I come back to you!

More information about the price, payment, and deposit can be found in the Retreat

Agreement document.

Retreat Application Steps:

1. Getting familiar with the True-Journey Offer

2.Answering Questionnnaire

3. Reading the Disclaimer & Retreat Agreement and agreeing to it (will be shared via email)

4. Having a 20-min call

5. If we agree that your participation is a good idea, then following up with submitting the Retreat Agreement and Disclaimer, if not yet done

6. Final Step: Paying the 1st Payment: your spot is reserved

Lots of love,

Ute

In general, for more information, visit the website! In case there are open questions,

please feel free to write an email to me.

www.true-journey.net

True-Journey E.I.R.L ; Email: ute.true.journey@gmail.com

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Shipibo Masterplant Retreats in Peru -Questionnaire for Retreat Application-

Shipibo Masterplant Retreats in Peru
-Questionnaire for Retreat Application-