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Intake Form
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Ayani Healing Intake Form

Today's Date*

Month

Day

Year

First name*

Last name*

Email*

Phone*

Birthday*

Month

Day

Year

Birthplace*

Time*

Time

:HoursMinutes

Gender*

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?

Emergency Contact Info:*

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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Date*

Month

Day

Year

Other Healing Options

Reiki Energy Healing $150

Soul Alignment Coaching $150

Self Paced Online Integration Program $333

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At Ayani Healing our Reiki sessions offer a gentle return to balance-a space where your body, mind and spirit can soften, open and remember their natural harmony. Reiki is a Japanese healing art that channels universal life-force energy through light touch or hands placed just above the body.

During your session, you will be guided into deep rest while healing energy flows to the areas that need support. Many clients describe feelings of warmth, tingling, emotional release, or a peaceful stillness that stays with them long after the session ends.

Reiki can support you in:

-Easing stress, anxiety, and emotional heaviness

-Calming the nervous system

-Encouraging deep relaxation and restorative sleep

-Supporting trauma healing and energetic clearing

-Reconnecting with your intuition and inner wisdom

All Reiki sessions at Ayani Healing are offered with grounded presence, compassion, and reverence. This is a sacred moment just for you - to unwind, reset, and receive the nourishment your spirit has been calling for.

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Experience profound personal transformation with our Soul Alignment Coaching at Ayani Healing. Our spiritual life coaching with Gabriela Sofia fosters a deep connection with your true self, guiding you towards a more fulfilling and balanced life. Through personalized on-line sessions that do NOT require any private guided session with medicine. We help you align with your inner purpose with your outer actions, ensuring every step you take resonates with your soul's call and healing journey. Embrace a journey of self-discovery, clarity, and spiritual growth with the intuitive guidance of our trauma informed experienced Gabriela Sofia. Let us support you in creating meaningful change from within.

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The medicine does not stop working when the ceremony ends or when the retreat is over. Plant Medicine initiates a healing process deep within our soul that unfolds over time, and can take months or years. The goal of integration is to maximize that healing process.

What is Integration?

We consider Integration to be the process of bringing separate elements of your experience during your journey together into a whole.We could say that it is the art of weaving the extraordinary into the ordinary, making sense of your journeys’ mystical and symbolic layers, revealing its gifts and treasures, and anchoring them into your lives.

Why is it so Important?

We are creatures of habit and our habits are often stronger than our insights. If we do not actively commit to ways of undoing our unhealthy habitual ways of being, our old physical tensions, behaviors, and tendencies will likely pop back up. Integration includes supporting and reinforcing the new healthy brain pathways through committed intentions and practical actions.

Enroll in our online 21-day

Self-Paced Integration Program

to support you in navigating bringing your journey back into your life.

These 21 days include different exercises, practices and guidance to help you successfully integrate the teachings of your journey. A program we recommend every participant joins post ceremony.

Pay and Subscribe

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