RETREAT APPLICATION FORM

Contact Information

About the Retreat

How did you find out about Yosi Ocha?

On which dates would you like to come to Yosi Ocha?

What type of accommodation do you prefer?
PrivateSharedIndifferent

Do you speak Spanish? If so, how would you describe your level:
I don't speak SpanishBasic user (I need translation)Intermediate user (I can communicate independently)Advanced user (I can assist others with English–Spanish translation)

Have you worked with Ayahuasca before? If so, please tell us briefly about your experience.

Have you had any experience with other psychedelic substances before? If so, please tell us briefly about it.

Were any of these experiences particularly difficult to integrate? Did you suffer from side effects?

Do you feel prepared to follow dietary restrictions on salt, sugar, caffeine, spices, dairy products, red meats, pork, processed foods, etc. during your stay at Yosi Ocha?
YesNo

Do you understand that during the retreat you cannot have any type of sexual activity, including masturbation?
YesNo

Please take the time to reflect and describe your intentions and the main aspects of your life that you would like to work on during this retreat (health problems, physical or emotional issues, traumas, fears, depression, addictions, etc.).

Why do you feel that working with Teacher Plants (Ayahuasca, San Pedro, Mapacho, etc.) can help you in this process?

Do you feel the call to train in shamanism and help others to heal?

Health Information

Tell us about any major health issue you currently suffer from, or have suffered in the past, including accidents or major surgeries.

Do you suffer, or have suffered from any of the following diseases?
Cardiovascular problems (heart attack, heart surgery, palpitations)High blood pressureEpilepsyDepressionAnxietySchizophreniaSuicide attemptAsthmaInfectionsContagious diseasesObesityOthers

Please provide more details about any item marked in the previous list.

Have you tested positive or suffered from COVID-19? If so, please tell us when? For how long were you sick? What treatment did you receive? Add any other information of interest related to this topic.

Have you been vaccinated against COVID-19? If so, please tell us when and which vaccine did you get? Did you have any side effects?

Are you currently going through a difficult period in your life?

Are you currently under psychological or psychiatric treatment? Do you receive any type of therapy?

Are you currently taking any medication? Since when and how much?

Are you currently taking an SSRI (selective serotonin reuptake inhibitor) or MAOI (antidepressant monoamine oxidase) antidepressant?

Have you ever attempted suicide or thought about ending your own life?

Does any member of your family suffer from mental disorders?

Do you drink alcohol? If so, how much?

Do you smoke? If so, how many cigarettes a day?

Do you use recreational drugs (marihuana, cocaine, MDMT, etc.)?

Do you have any type of addiction (drugs, alcohol, food, sex, etc.)? If so, please elaborate.

Do you have any particular phobia (insects, animals, etc.)?

Do you have any allergies to medications, animals, insects, plants, etc.?

Do you have any dietary restrictions? (vegetarian, vegan, celiac, lactose intolerant, etc.)

Are you taking any homeopathic medicine, supplements, etc.?

Are you, or do you think you might be pregnant?

Please share any additional information that you think we should be aware of.

Please attach your photo. Maximum 3MB (required)

Consent

By submitting this form I certify that:
– I have read and accepted Yosi Ocha's Terms and Conditions.
– I have read and accepted Yosi Ocha's Privacy Policy.
– All the information I have provided is true and I have not omitted any essential information of interest for this retreat.
– I release Yosi Ocha from any responsibility for any physical or mental health problems that I may suffer during my stay at the center, related to previous problems in my health and that I have omitted in this application form.