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Answer all of the below questions. If the answer is no, please indicate this.
Consumption History – please indicate which substances you have used, the frequency and the approximate date of last use.

* Medications, Vitamins, Supplements:
Many medications and supplements, including but not limited to MAOI’s inhibiting medications, SSRIs, and/or anti-depressants (including St John's Wort), and other medications do not mix well with Ayahuasca and pose a serious health risk or can even be fatal if taken in conjunction with Ayahuasca. Guests are not allowed to take any sort of medication, vitamin or supplement during their preparation process and while at the retreat center. Therefore, no guests will be allowed to come to the retreat who cannot safely refrain from taking medication in the preparation process and for the duration of the retreat. We will further advice on the duration of abstinence. If you are taking any medication or supplements prescribed by a doctor, you will need to consult your doctor about weaning off them so they are completely cleared from your system before your visit. Medication for anti-malarial, birth control, pain-killers, anti-diarrhea, antacids, altitude and travel sickness medication, thyroid medication and others should be made known to the Willkamayu staff prior to the retreat. Again if you use any medication we will further advice for abstinence.

* Health Conditions and Risks: We are NOT a medical facility and we are not equipped to handle a serious medical emergency. Please inform us of any serious medical conditions that you have before you make your reservation.
The people who are not suited to taking Ayahuasca can engage in other Ancestral therapies such as coca leaf readings, cleansing and flourishing ceremony, and the offering to the mother earth, Pachamama and the Mountains.

Due to potential health risks, people with the following health conditions will not be able to take Ayahuasca:
* High blood pressure (Please consult to us)
* Diabetes
* Pregnancy
* Schizophrenic disorder
* Heart disease or any condition previously diagnosed indicating vulnerability to the heart
* Epilepsy and other seizure related conditions
* Use of MAO inhibitors or anti-psychotic medication
* Any form of brain surgery.
* Abdominal surgery within a 6 month time frame.
* Mental Illness: Anyone in treatment for mental illness must consult a physician regarding the use of
Ayahuasca. If given clearance, patients must cease taking anti-depressants or mood-altering medications
at least 3 months prior to the retreat.

* Sensitivity to Tobacco: Tobacco is an integral part of Amazonian and Andean shamanism and it is frequently used by the Shamans during ceremony. If you have a hyper sensitivity to tobacco smoke, you should inform us before booking your retreat.
*We believe in having animals around our center because the energies that the animals give off are of positivity. If you are allergic to dogs & cats then you should advise us.

Acceptance of the Maestro and the Technique
Guests must declare themselves willing to comply fully and for the duration of the retreat with the Maestro guidance and instructions; that is, to observe the discipline and to practice exactly as the Maestro asks, without ignoring any part of the instructions. This  acceptance should be one of discrimination and understanding, not blind submission. Only with an attitude of trust can a patient work diligently and thoroughly. Such confidence in the maestro/maestra and the technique is essential for success during your retreat.

Do you accept?

* Please let us know if you are on any medication, have any serious health problems, infectious or contagious disease

I have read and answered all of the questions honestly and am aware that any medical problems that may arise are not the responsibility of Moving into Rhythm, facilitators or medical practitioners.

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