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Health Form

I want to make a journey with
I declare that (if necessary in consultation with my doctor) I am prepared to abstain from alcohol, drugs, medicines, nasal sprays and/or supplements for at least three days, and in some other cases two weeks, for my own health and well-being.
Do you have high blood pressure or heart defects?
Do yu want to participte in th University of Maasticht' research?
Do you have experience with Ayahuasca or other entheogenic medicines?
I declare that I have answered this fully and truthfully.
I agree to the terms of delivery

Bedankt voor uw gezondheidsformulier.

Uw gegevens worden te nimmer aan derden verstrekt en twee dagen na de ceremonie uit ons systeem verwijderd.

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