Elevitality | Retreat Questionnaire

Retreat Questionnaire

This questionnaire serves as a compass, guiding us to comprehend the depth of your intentions and aspirations as you seek to embark on a transformative journey with Tepezcohuite, the revered Mayan Tree of Life. It's a step toward embracing the sacred medicine that promises enlightenment and renewal.

Name

Phone Number

Tepezcohuite is renowned as an exceptionally potent botanical remedy for genuine self-healing. Often referred to as the "Mayan Love Ceremony," engaging with this plant allows one to experience a profound connection to divine love. What draws you to explore healing with this ancient Mayan medicine?

What are your goals, hopes, and expectations?

What are your concerns or fears?

What is present for you at the moment? What are you moving through? What are you experiencing in your life?

Do you have prior experience with Plant Medicine Journeys? If so, which Plant Medicines have you journeyed with before? How was your experience?

Do you have any current or past psychological or psychiatric conditions or diagnoses? If yes, please give the dates and describe the circumstances.

Are you currently taking any prescription drugs/medication that we should be aware of? If yes, which ones & why?

Lastly, what is your Intention for this Ceremony?

Retreat Questionnaire

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