Medicine and Community Weekend Retreat

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1 Welcome

2 Price

3 Participant Info

Phone *
Age *
Gender *
Address
Address 2
City
State/Prov.
Zip/Postal
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Have you sat with this medicine before? *
What is your intention/reason to sit with this medicine *
Do you have a history of any of the following medical conditions. *	Crohn's disease Heart conditions High blood pressure Irritable bowel syndrome Seizures Self or family history of Bipolar/ Schizophrenia None of the above
If you answered yes to any of the above, please expand on the details *
Please list any prescription medications you currently take or have taken in the last 30 days *
Please elaborate, last time, what dosage and how often *
Do you use any alcohol, marijuana or any other recreational drugs *	Yes No
Please elaborate, last time, how much and how often *
If required, what is the best time to schedule a 15-minute intake call *
Comments or Special Needs *
Terms and Conditions *	I accept the terms and conditions.Deposits and payments are non-refundable but may be used as a credit towards future bookings.
Please let us know who referred you? *
Payments do not include the cost of plant medicines. *	I understand that payments made through Retreat Guru do not include the cost of: plant medicine, psychedelics or similar products. There will be no additional charges for this retreat.Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service.

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1 Welcome

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General A/C'd Ceremony Area

Loft (Single Room)

Queen Room

Fireplace Queen Room

Twin Share

3 Participant Info

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6 Payment