Personal and health data in this form will be used only for suitability, safety and communication related to the ceremony.
1
Personal Information
2
Medical Screening Tick one per question
1.Are you currently suffering from any illness?
2.Are you currently taking any medication?
3.Do you have any cardiovascular, nervous system or digestive condition?
4.Do you have psychiatric history, treatment, or relevant family background?
5.Have you received any vaccination in the past 6 months, including COVID?
3
Background, Habits and Preparation Tick one per question
6.Have you been using any substance?
7.Do you practice yoga, Chi Kung, meditation, gym or other techniques?
8.Have you previously taken any of the Master Plants?
9.Do you currently consume psychoactive substances, drugs, alcohol or weed?
10.Do you eat meat?
4
Informed Consent, Confidentiality and Liability

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