Ayahuasca-Wasi

CUSCO AYAHUASCA WORKSHOPS

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Online medical questionnaire

Please answer the following questionnaire.
We ask you to tell us if you have any disease, pathological or functional problem not considered here.

Name and surname: *req.
E-mail: *req.
Country:
Occupation:
Date of birth:		(dd-mm-yy)
Sex:		Male. Female.
Marital status:
Passport number:
Contact in case of accident:
Phone number:

Answer the following questions only if affirmative.
Blank answers meanning NO.

Do you have any disease? If yes, please, explain.

Do you have any special psychological condition? If yes, please, explain.

Do you have any dietetic program? If yes, please, explain.

Psychoactive substances use

Substance	Frecuency	Last consumption
Cocaine
Crack
Opiaceous (opium, morphine, heroine)
Marihuana / Hashish
Alcohol
Pills
LSD
MDMA (Extacy)
Others

Are you currently taking any medication? If yes, please, explain.

Do you have any experience with modified states of consciousness? If yes, please, explain.

Do you have any experience with ritual context use of psychotropic plants like San Pedro, Peyote, Ayahuasca, Hongos, Wilca, etc? If yes, please, explain.

Do you practice meditation, yoga, reiki, bioenergy or another self-exploration technique? If yes, please, explain.

How do you find us?

Do you have any problem not indicated in this questionnaire? If yes, please, explain.

Cusco
Upcoming Workshops

Status	Dates
Available	Sep 20 - 26, 2008
Full	Nov 7 - 13, 2008
Available	Dec 6 - 12, 2008
Available	Jan 17 - 23, 2009
Available	May 23 - 29, 2009
Available	Aug 22 - 28, 2009

Testimonies

Take a look at participant previous experiences

Amazon Ayahuasca Workshop

7-day Ayahuasca workshop in the heart of the Peruvian rainforest.
Puerto Maldonado.

Pisaq community

Visit our small comunity in Pisaq town (Sacred Valley) and arrange an Ayahuasca ceremony

Visit our articles section where you can find more information about this ancestral medicine.

Icaros, medicine songs
and mantras

Spiritual Teachings

about us

Links