Name

First Name

Last Name

Phone

Country

(###)

###

####

Website

http://

Date of Birth

How did you hear about us?

Starting date of your preferred retreat

Preferred occupancy type

Single Bungalow w/ Ocean View 5,950 USD

Single Bungalow w/ Jungle View 4,950 USD

Double Bungalow w/ Ocean View 4,950 USD

Double Bungalow w/ Jungle View 3,950 USD

Are you planning on coming with a friend or partner?

What do you want to get out of this retreat?

How has your experience with plant medicine been so far?

How would you describe your overall health? Do you have any medical conditions? Are you currently taking any prescription drugs?

Have you ever been diagnosed with schizophrenia or any mental health disorder?

Do you have any allergies or food restrictions?

With our approval and your downpayment, your space is securely booked. You will receive an email with detailed information shortly.

If you have any further questions or need clarification on personal issues, please feel invited to talk to us.