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Application Form

Name(Required)

Date Of Birth(Required)

Gender(Required)

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Female

Email(Required)

Phone(Required)

Address(Required)

Nationality(Required)

Person to Contact in case of Emergency:

Name(Required)

Surname(Required)

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Relationship(Required)

About the retreat

On What Dates would you like to come?

Do You Speak Spanish? If Yes

I Don't Speak Spanish Basic User (I Need Translation)

Intermediate User (I Can Communicate Independently)

Advanced User (I Can Help Others With English-Spanish Translation)

Have you worked with Ayahuasca before? If So

Have you had any Experience with other Psychedelic Substances before? If Yes

Were any of these Experiences particularly difficult to Integrate? Did you suffer Side Effects?

Do you feel Prepared to follow Dietary restrictions on Salt, Sugar, Caffeine, Spices, Dairy, Red Meat, Pork, Processed Foods, etc. During your stay at Yosi Ocha?

Yes

Do you understand that during the Retreat you may not engage in any type of Sexual Activity, including Masturbation?

Yes

Do you use Recreational Drugs (Marijuana, Cocaine, MDMT, etc.)?

Do you Have any Addictions (Drugs, Alcohol, Food, Sex, etc.)? If Yes

Do you Have any Particular Phobia (Insects, Animals, etc.)?

Do you Have any Allergies to Medications, Animals, Insects, Plants, etc.?

Do you Have any Dietary Restrictions (Vegetarian, Vegan, Celiac, Lactose Intolerant, etc.)?

Do you Take any Homeopathic Medicines, Supplements, etc.?

Are you or Do you think you might be Pregnant?

Please Share with us any Additional Information you think we Should Know.

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Note :

I have read and accept Isa Yaka's Terms and Conditions.
I have read and agree to Isa Yaka's Privacy Policy.
All the information I have provided is true and I have not omitted any essential information of interest to this retreat.
I release Isa Yaka from all responsibility for any physical or mental health problems that I may suffer during my stay at the center, related to previous problems in my health that I have omitted in this application form.