Ceremony – Private - Plant Medicine Retreat Thailand

First Name

Last Name

Phone

Country

Confirm Email

Gender

Date of Birth

Language Spoken

Select Plant Medicine Journey

Grandmother Vine Ceremony Bufo Ceremony Kambo Ceremony Medicine Assisted Psychotherapy

Requested Dates for Private Ceremony: (Please note: Your requested dates are an availability preference only and are not confirmed until approved by our facilitation team. Please do not book flights or accommodation until you receive confirmation.)

Number of People Attending (except 1:1)

Grandmother Vine Ceremony Only: Number of Ceremonies

Room Type

Private Standard room Private Deluxe room

* After you are approved for the inquired retreat, a non-refundable deposit will be required to book your spot.

How long have you been considering a plant medicine journey?

1 - 6 Months 6 - 12 Months 12 - 24 Months 2+ years

Please describe your motivation for wanting to participate in a plant medicine ceremony. What specific experiences or challenges lead you to this decision?

Detail your previous experiences with psychedelics, including plant medicines, and describe how they impacted your personal development and emotional well-being?

Describe a significant challenge or transformative event in your life and how you handled the changes it brought. How do you think this experience has prepared you for plant medicine?

If you have selected yes to any of the above, please detail any ongoing mental health treatment or therapy.

Detail any significant health issues you have had in the past five years, including how they were managed and/or resolved. How do you currently maintain your health?

How do you currently manage stress and emotional challenges in your everyday life? Please provide examples of strategies or practices you use.

What does spiritual connection mean to you, and how do you currently explore or express your spirituality?

What are your intentions for this Plant Medicine ceremony? What outcomes would make it successful for you?

Certain drugs and medications are not compatible with psychedelics. It is essential to discontinue some medications, particularly antidepressants and allow sufficient time for your system to clear them before participating in a retreat. Please consult your doctor if you have any doubts and do not abruptly stop taking prescribed medications, including antidepressants, without medical advice.

Please list all the medications and all supplements you are currently taking in the box below (e.g. Prozac, Lexapro, Valium, etc.)

Do you have any chronic diseases/conditions? If so, please list the name of the medications currently used.

Do you have any known allergies? If so, please elaborate.

Do you have any conditions with the kidneys? If so, please describe.

Do you have high blood pressure? If so, please state the latest blood pressure values.

Do you have Thalassemia or Thalassemia trait?

Illegal and recreational drugs are dangerous combined with some MOAIs. Please list all the substances used in the last 30 days in the box below (MDMA, Cocaine, Methamphetamine, etc.)

Do you have any fears regarding attending the ceremony?

Describe your support system. Who in your life understands or supports your decision to explore plant medicine? How do you plan to integrate your experience post ceremony with their help?

As a part of Plant Medicine Thailand Group retreats, two post integration group sessions are included to ensure ongoing support and integration of your experience. Do you think these are important and are you willing to attend?

Yes No

Although, it has been proven scientifically that taking plant medicine under the supervision of trained specialists is very safe, there are still unforeseeable risks that might happen during or after the treatment. Do you understand the risks and are willing to take your own responsibility?

Yes, I understand No

Begin Your Private Journey

Private Ceremony Application