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SYNCHRONY

Application Form

Thanks so much for your interest in SYNCHRONY!
Please fill out this form below so we can understand more about you and your interest in this experience. If you have any questions, please feel free to email us.

First Name

Last Name

Email

Phone

Which Event/Date are you interested in?

Which Event/Date are you interested in?
A
B

What inspired your interest in this experience? 

Have you worked with plant sacrament or psychedelics before?

Have you worked with plant sacrament or psychedelics before?
A
B
If yes, please share some of your experience.

Do you have any health concerns regarding this kind of work?

If so, please elaborate.

Do you have any current or past medical conditions?

(e.g., heart disease, hypertension, diabetes, epilepsy, or respiratory issues)

Are you currently taking any medications, including prescription drugs, over-the-counter medications, or supplements?

If yes, please list them, including dosage and frequency.

Do you have a history of mental health conditions? If yes, please provide details and any current treatments.

(depression, anxiety, PTSD, bipolar disorder, schizophrenia, or other diagnoses)

Have you ever experienced a psychotic episode or been hospitalized for mental health reasons? If yes, please describe.

Are you currently under the care of a therapist, psychiatrist, or other mental health professional? If yes, have you discussed your participation in a Huachuma ceremony with them?

Do you have any history of substance abuse or addiction? If yes, please provide details and current status.

(alcohol, drugs, or prescription medications)

Have you experienced adverse reactions to psychoactive substances, plant medicines, or stimulants in the past? If yes, please describe.

Do you have any allergies to plants or substances that might be used in the ceremony?

(cactus, tobacco, or other herbs)

Are you willing and able to follow a pre-ceremony dieta and preparation guidelines ?

(avoiding certain foods, alcohol, or medications for a specified period)
Are you willing and able to follow a pre-ceremony dieta and preparation guidelines ?
A
B

Are you prepared to abstain from sexual activity, recreational substances, and certain stimulating activities (media, caffeine) before and after the ceremony, as recommended?

Are you prepared to abstain from sexual activity, recreational substances, and certain stimulating activities (media, caffeine) before and after the ceremony, as recommended?
A
B

Are you able to commit to the full duration of the ceremony, including any pre and post-ceremony activities such as Preparation and Integration trainings (over Zoom)? Please explain.

Are you able to arrange transportation to and from the ceremony location?

Are you able to arrange transportation to and from the ceremony location?
A
B

Can you give us a brief description of your relationship to Spirit (spirituality)?

What are you focusing your attention and energy on in your life?

What are you ready to transform or activate in your life?

What is your primary intention for participating in this Huachuma ceremony?

(spiritual growth, emotional healing, physical healing, personal clarity, or other goals)

Are you comfortable with the potential for intense emotional, physical, or visionary experiences during the ceremony?

Are you comfortable with the potential for intense emotional, physical, or visionary experiences during the ceremony?
A
B
C

Are there specific issues, challenges, or questions you hope to address during the ceremony?

What are your expectations for the ceremony experience, and how do you hope to feel afterward?

Thanks so much for taking this important step towards your healing and expansion.
We look forward to connecting with you!