Hello 1

Ayahuasca & Plant Medicine Treatment for Depression, PTSD, Trauma (1-3 months)

Flexible Dates

- With Sanango, Ananda, Mikaela and Arjuna

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1 Choose the dates of your stay

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Minimum stay is 30 nights

2 Price

$105.00 – This the initial cost of application for the process (later discounted from your process), which includes an extensive medical screening, and an initial online consultation with Maestro Sanango to diagnose your case (including personalized preparation regimen before arrival, definition of length of your process, and cost).

3 Participant Info

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First Name *
Last Name *
Email *
Phone
Comments or Special Needs
Gender
Birth Date
Address
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How did you hear about us? *
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National Identification Number OR Passport number
Please list any physical medical conditions, serious injuries or surgeries you have had in the past or are presently dealing with. *
List any allergies you have. *
List any conditions of depression, anxiety or other psychological conditions that you currently experience or have experienced in the past. *
Please list any medication or natural supplements you are taking. *
List any recreational drugs you are currently using in your life or have used in the past, as well as amount and frequency. *
Do you have previous experience with Ayahuasca, San Pedro, Peyote, Mushrooms or other in shamanic or recreational contexts? If you have please share your experience. *
Please share any additional informations or comments that could be useful for us to know. *
What are your intentions for working with this medicine? Why do you feel called to work with Ayahuasca. What are the most important things you wish to understand or heal about your life? *
Terms & Conditions *	I agree to the Sinchi Runa Terms & Conditions and Retreat Rules By clicking “I agree”, I declare to have have read, understood, and agree to the terms and conditions of Sinchi Runa in order to attend a retreat with Sinchi Runa, as found on the Sinchi Runa website (https://sinchiruna.com/terms-conditions/). I declare to have fully and truthfully disclosed my medical history, physical and psychological conditions, and history of substance abuse, as well as all medications, substances or supplements that I am taking or have taken. I declare to have read and understood the contraindications with plants used on the retreat, as found on the Sinchi Runa website (https://sinchiruna.com/contraindications), and that I will not consume any contraindicated substances minimum 4 weeks before the retreat, including but not limited to psychiatric medication and prescription medications (antidepressants, anti-anxiety, antipsychotics, anticonvulsants, benzodiazepines, anti-parkinsons medications) and all narcotics (including but not limited to cocaine, MDMA, ecstasy, amphetamines, opioids and alcohol). I understand and agree that it is exclusively my responsibility to clarify any doubts regarding contraindicated substances with Sinchi Runa in time for the retreat. I understand that it is exclusively my responsibility to transparently disclose my medical history and usage of all medications and substances, and agree to waive my right to participate in a retreat in the case of contraindications, and/or omitted or incorrect information regarding my medical history or substance usage that Sinchi Runa deems to be a safety risk, without reimbursement of the retreat cost.

4 Donate

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$	Thank you for giving others the opportunity At Sinchi Runa, we deeply believe that the opportunity to heal with Ayahuasca and Master Plants should be available to all. We try to accommodate our retreats for those with less means as much as we can. Your support in giving others the opportunity, regardless of amount, is received with our deepest gratitude.

5 Payment

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	If you have a European bank account you can pay through bank transfer free of charge. In order to complete the registration please pay the deposit to the account below and send us a confirmation with a copy of the of transfer through email within 24 hours. Please send the corresponding payment in Euros € instead of American Dollars (you can convert currency on www.xe.com). Thank you! NAME: ASOCIACION SINCHI RUNA  IBAN: ES94 0182 0454 8102 0162 2600 BIC/SWIFT - Swift: BBVAESMMXXX Click on the button below and these instructions will be repeated on the next page.

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