( Ritual Embodiment )

( Sacred Responsibility )

Assessment

Please take the time to complete this form. It is the first step to register for any of our retreats. Fields marked with an * are required. If you have previously filled this form out please contact us directly to register.

Many Blessings

Retreat Selection

First Name

Last Name

Country of Residence

Province/State

Phone

Gender

Male Female Other

Age

Other Food Allergies

Profession

Emergency Contact: Name/Relationship/Email/Phone

How did you hear about retreat?

Personal Journey & Reasons to Come Work With Ayahausca

Previous Plant Medicine Experience

Participation Concerns in an Amazonian Plant Medicine Ceremony

Past / Current Serious Health Conditions

Ever Hospitalized (Medical)?

Ever Hospitalized (Psychiatric)?

Currently Taking Medications? (List)

Ever Taken SSRI Meds?

Medications Past 12 Months

History of Depression/Anxiety/Psychosis/ADHD

Consent: I consent to participate in the ceremony and confirm that my medical information will be kept confidential and used solely to ensure my safety and well-being.

Yes No

Confirmation: I confirm that all information provided is complete, accurate, and given honestly, and that I am in good general health.

Yes No

Deepening Your Understanding of the Path and Our Practices

Find clarity on our traditions, safety protocols, and the sacred journey of the plant medicine experience.

What are the Ancestral Wisdoms Traditions and how do you honor it?

We are deeply rooted in the Ancestral Wisdom Traditions of the Peruvian Amazon. Our work is guided by traditional icaros (sacred songs) and ancestral techniques passed down through generations, ensuring the medicine is practiced with the highest cultural integrity.

How do you ensure the safety and integrity of your retreats?

Safety is our foundation. We maintain high-integrity spaces via thorough medical screening, trained facilitators, and small group sizes. We bridge ancient healing with modern safety standards to provide a secure environment for deep soul work.

What is a Master Plant Dieta and who is it for?

A Dieta is a dedicated period of communion with a specific teacher plant. It is designed for students seeking deeper healing or training. We offer both immersive and remote containers to support your unique level of experience.

Do I need prior experience with plant medicine to join?

No prior experience is necessary, but a heart open to “Radical Faith” and transformation is essential. We offer guidance for both beginners and long-term students of the medicine path to ensure everyone feels supported.

How does Earth Temple practice ecological stewardship?

We believe in a reciprocal relationship with the land. A portion of our proceeds goes toward philanthropy and replanting initiatives in the Amazon, ensuring we give back more than we take from the ecosystems that sustain us.

What is the importance of "Integration" after a retreat?

Integration is where the healing takes root. We provide resources, prayer, and meditation practices to help you bridge the wisdom gained during ceremony into your modern, daily life for lasting transformation.

What should I do to prepare for my journey?

Preparation involves both physical and spiritual alignment. We provide a detailed guide on the “dieta” (dietary) requirements and intentional practices to help you arrive with clarity and openness to the Great Spirit.

How does Earth Temple support planetary healing?

Our mission is built on the belief that personal healing is planetary healing. By helping individuals return to their divine nature and live in harmony with the Earth, we contribute to the collective awakening of all beings.

Download Athena's free meditation album

Get a feel for Earth Temple!

A free collection of guided meditations, prayers, ikaros, and shamanic transmissions to reconnect you with your divine essence. Led by Athena Naia, a medicine woman and curandera.

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