Participant Intake Form

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The following form helps us understand a little bit more about you and how we can best ensure that you have a meaningful and safe experience during our sacred healing ceremonies. Please take into consideration that this is a religious ceremony, not a medical or wellness procedure or facility.

All members must complete an intake form prior to attending ceremony. First time participants will be required to complete an additional screening via phone call.

All of your responses are entirely confidential. Please read each question and answer carefully. If you would prefer not to answer a question, please leave it blank.

Participant Information

Have you ever experienced any of the following:

Please use this section to share any questions or concerns you have.