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Ceremony Intake Form

Thank you for choosing Sacred Jaguar Medicine. It is an honour and privilege to serve and work with you on your healing journey.

The ceremony is primarily a spiritual undertaking and although personal growth can occur, the experience should not be seen nor is it designed as a substitute for psychotherapy. Participation in the ceremony can involve dramatic experiences accompanied by strong emotional and physical release. This ceremony is not appropriate for persons with certain medical conditions or for persons using certain medications. If you have any doubt or concerns about whether you should participate, consult with the organizers before attending.

Participants must answer the following questions honestly in order for us to evaluate your ability to attend the event. Failure to disclose any medical condition or medication can result in hazardous conditions for the participant and you assume full liability for yourself in this instance. The organizers accept no liability for any conditions arising from false or incomplete information provided by event applicants.

Cardiovascular Disease
Heart Attacks
High Blood Pressure
Low Blood Pressure
Depression
Anxiety
Surgery within past 12 months
Dental work within past 12 months (other than routine cleanings)
Past or Present Physical Injuries (ie concussions, torn ligaments)
Broken Bones
Transplant Recipient / Donor
Glaucoma
Retinal Detachment
Infectious Disease
Epilepsy / Seizure History
Family History of Epilepsy / Seizure
Asthma
Diabetes
Schizophrenia
Narcissistic Personality Disorder
Diagnosed Asperger's
Diagnosed Autism
Skin Conditions
Liver Issues
Circulation Problems
Intestinal / Bowel / Digestive Disorders
Head or Neck Injuries
Sleeping Disorders
Bladder or Kidney Issues?
Back Injury
Are you pregnant?
Are you breastfeeding?
Are you taking birth control?
Have you received the Covid 19 vaccine?
Are you currently receiving hormone therapy?
Have you been diagnosed with an autoimmune disorder?
Are you currently taking prescription medication?
Are you currently taking homeopathic remedies?
Are you currently taking vitamins or supplements?
Are you currently using recreational substances?
Are you currently taking any pain killers?
Are you currently taking medication to quit smoking?
Do you have any allergies?
Is there anything else we should know about your medical history before we can determine your safety in participating?
Have you sat with plant medicines before?
I understand that in signing this form, I am agreeing to partake in a spiritual ceremony and that my admission is based on the information provided in this form
I am signing this form of my own free will and hold no liability to Sacred Jaguar Medicine, its practitioners or other participants in the event that I have provided false or misleading information that is detrimental to my mental health and physical well-being

Thanks for submitting!

Help Protect the Tribes

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These medicines can only be available if we work together to help protect the tribes who collect them and the jungles of the Amazon, home of the Frogs & Tree of Life.

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10% of all proceeds go towards keeping this mission alive.

All medicine comes directly from the Matsés people in Peru & Tepezcohuíte shamans in Mexico.

Sacred Pathways Spiritual Retreats
The IASP
Quantum Consciousness

© Sacred Jaguar Medicine | All Rights Reserved

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