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Home
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Private Guided Psilocybin Journey
Post-Journey Integration
Reiki Energy Healing
Soul Alignment Coaching
21-Day Integration Program
Private Guided Psilocybin Journey
Post-Journey Integration
Reiki Energy Healing
Soul Alignment Coaching
21-Day Integration Program
About
Intuitive Channeling
Resources
Intake Form
Dieta
Films
Books
Preparation
Testimonies of Transformation
Intake Form
Dieta
Films
Books
Preparation
Testimonies of Transformation

Home
My Offerings
Private Guided Psilocybin Journey
Post-Journey Integration
Reiki Energy Healing
Soul Alignment Coaching
21-Day Integration Program
Private Guided Psilocybin Journey
Post-Journey Integration
Reiki Energy Healing
Soul Alignment Coaching
21-Day Integration Program
About
Intuitive Channeling
Resources
Intake Form
Dieta
Films
Books
Preparation
Testimonies of Transformation
Intake Form
Dieta
Films
Books
Preparation
Testimonies of Transformation

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Intake Form

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Do you have a daily/weekly spiritual practice? If so, please explain:*

Have you journeyed with (plant/or other) medicine before (Examples: Ayahuasca, San Pedro, Huachuma, Psilocybin (mushrooms)?*

How did you hear about us?

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Do you have any physical health conditions? If so, what are they:*

Do you have a mental health condition?*

Are you currently on any medications?*

If so, what and how much do you take?*

Would you like to book a consultation call with us?

Listen closely to what has drawn you to this ceremony. Please describe your intention for the ceremony, apart from your main intention?*

Have you taken MDMA before? If so, how often and how many milligrams did you take?*

I take full responsibility for my own belongings and safe transportation to and from the retreat location, The Wellness Center _______(Initial)*

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I agree that I always have a choice whether or not to participate, and I agree to take full responsibility for choices I make involving this work, both during and after the event ______(Initial)*

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To the best of my knowledge, I am in good physical condition and not aware of any physical or psychological infirmity which would place me at risk to participate in the ceremony activities ______(Initial)*

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I agree to participate with the purest intention of the heart, promoting the health and well-being of myself and all participants ______ (initials).*

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I agree I will leave the ceremonial space for my own safety after the ingestion of plant medicines started earlier until the ceremony is officially closed by the facilitator/s. ______ (initials).*

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To maintain safety, trust and respect for all participants, I agree to hold this work confidential. I will not reveal to anyone the identity of those who are participating in the event _________(initials).*

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I understand that the facilitators and their team reserve the right to deny my participation if they deem that it would be unsuitable/unsafe for me to participate _________(initials).*

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I hereby release, waive, discharge and commit not to sue the event leader, organizers and/or participants for any and all liabilities, claims, demands arising from or related to the event.________(initial).*

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In signing this agreement, I acknowledge that I have read and understand the above terms and conditions and signed voluntarily. I fully release Gabriela Sofia Santivanez of any liability. Sign full name below. We require either a deposit or a full payment*

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© 2026 Ayani Healing. All rights reserved.

Ayani Healing provides education, preparation, and integration support only. Services do not include the administration, facilitation, or provision of any controlled substances and are not a substitute for medical, psychological, or psychiatric care.

Heal · Transform · Remember. A sacred space for those walking the path of remembrance.

© 2026 Ayani Healing. All rights reserved.

Ayani Healing provides education, preparation, and integration support only. Services do not include the administration, facilitation, or provision of any controlled substances and are not a substitute for medical, psychological, or psychiatric care.

Heal · Transform · Remember. A sacred space for those walking the path of remembrance.

Home
My Offerings
About
Intuitive Channeling
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