This form MUST be filled out and submitted before you can book a session

Your details are kept strictly confidential and are only used by the Companionship for contacting you about your ceremony or after-care support.

The ceremony facilitator must receive this form as part of your registration for your ceremony. We cannot confirm your place at the ceremony until you have completed this form.

Information about the Ceremony

Companionship Ayahuasca ceremonies are intended to be a personal growth experience. Working with ayahuasca can involve intense experiences accompanied by strong emotional and physical releases. It is not recommended for people with serious cardiovascular problems, serious hypertension, severe psychiatric conditions (check with your facilitator), recent fractures or surgery, acute infectious diseases, or spiritual emergencies.

If you have any doubt as to whether you should participate in the ceremony you may want to consult your doctor or therapist as well as the organizers of your ceremony.

Application Form

Please answer all questions as fully as possible.