Plant as Medicine: Ceremonial Journeys
The ceremony: opening with breathwork and a drumming sound journey, you will choose your medicine (or a combination) that aligns with your intention: Psilocybin (mushrooms), Kava, Hape', Cacao.
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MAGNOLIA RETREATS APPLICATION CONSIDERATIONS


Our programs are suitable for those seeking:

– Personal and spiritual transformation 
– Deepening connection with self, nature, and purpose
– Improved relationships
– An exploration of mystical realms
– A spark in creativity and sensual living

Psilocybin & other plant medicines are generally speaking safe compounds with few major side effects. That said, any pre-existing health conditions and circumstances could be contraindicated for this experience. Before taking the time to fill out an application, we require that you thoroughly review your health history and Magnolia Retreat considerations, including (i) physical, health, and psychiatric conditions, (ii) medications and treatments, and (iii) family history and other risk factors that would either (a) disqualify you from participating or (b) require that you confer with a physician and obtain their advice or approval before participating.

Please note that we do not make any medical or therapeutic claims about our retreats or ceremonies. The application process and our ceremonies are not designed to diagnose, make medical recommendations, or offer treatment solutions; however, for your safety and the safety of other participants, we may determine that it is not advisable to participate. This document is also presented for your convenience, to assist you with understanding any potential risks of participating in a Magnolia Retreat offering. This form should not be relied upon to reach any conclusions about whether it is safe for anyone to participate–only you and your doctor or other medical professional can make that determination. By completing this application you confirm you have read and understand the  considerations listed above.

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Have you been summoned by the plants?
Name *
Phone Number *
Address
Are you currently taking any prescription medicine or supplements? *
Are you under the care of a Physician? If yes, what was the nature and date of your last visit? *
Please provide an Emergency Contact

Evidence shows a worldwide history of the use of psychedelic mushrooms & other plant medicines, spanning the Americas to Algeria, France to Spain, and beyond. Across place and tradition, the ceremonial use of plant medicine has been revered as a way to alleviate emotional wounds, promote personal growth, and enhance spiritual connection. At Magnolia Retreats, we bridge the ancient wisdom and tradition of these ceremonies with quantum science research and experienced clinical knowledge to create space for transformational personal growth. 

Would this be your 1st ceremony or experience with plant medicine?


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What is your intention for requesting this type of ceremony? *
Please select all scenarios below that apply to you. 
Pregnant or planning, extremely ill/frail, allergic to mushrooms, or allergic to burning herbs/sage.
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Required
Do you have or have you had any of the following medical conditions?

- Epilepsy or other seizure disorder
- Asthma
- COPD
- Kidney disorders/irregularities urinating
- Liver disease
- Uncontrolled High blood pressure
- High blood pressure (well controlled by medication)
- Other Cardiovascular disease
- Diabetes Type I (insulin dependent, well controlled)
- Uncontrolled Diabetes Type II
- Diabetes Type II (well controlled by diet or non-insulin medication)This question is required.*

Or please type: NONE OF THESE APPLY TO ME.
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Have you ever had any adverse reactions to alcohol, drugs, or any other consciousness-altering substances?
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Do you or have you experienced substance abuse or addiction?
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Please indicate if you heavily consume any of the following substances (more than 4+ times weekly or multi-day binge) .
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Required
Support Systems:
What is your current relationship status?
How satisfied are you with your relationship) ?
This work may lead to profound shifts in your life and it is ideal to have a framework of resources in place ahead of time to support you before, during and after sessions. 

Having support to help you integrate the experience can help you to get the most benefit from the work. 

Do you feel well supported by friends, family, and/or other trusted person(s), such as a therapist, pastor, or health coach, who knows you are applying for this retreat? 
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By whom do you feel well supported by? This question is required.*

Friends, family, and/or other trusted person(s), such as a therapist, pastor, or health coach who knows you are applying for this retreat?

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Why do you feel drawn to this program? 
What are your hopes or expectations? 
Do you have any concerns? This question is required.*
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Clear selection
Mental/Emotional Wellbeing

We are aware that some of these questions inquire about very personal and potentially sensitive material. We sincerely appreciate you being direct and forthcoming in your answers and we want you to take care of yourself while you are completing this section. If at any point in time you notice that you are becoming agitated or spaced out, please feel free to pause and come back to it once you are feeling more calm and/or attentive.

In general, how content do you feel in your life? *
Very dissatisfied
Very Satisfied
I find it hard to wind down: *
Extremely disagree
Extremely agree
I experience frequent dryness of mouth: *
Required
I experience breathing difficulty (e.g., excessively rapid breathing, breathlessness in the absence of physical exertion) 
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I sometimes feel that I have a lot of nervous energy.
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Required
Are you currently being treated for or have you ever been diagnosed with any of the following?

Schizophrenia
Schizoaffective Disorder
Bipolar Disorder I
Bipolar Disorder II
Personality Disorder 
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Have you ever had a psychotic episode? 
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Are you currently being treated for or have you ever been diagnosed with:

PTSD, 
cPTSD, 
Major Depressive Disorder
General Anxiety Disorder
Obsessive Compulsive Disorder
Other Mood Disorder 
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Psychedelic experiences can be emotionally and psychologically challenging. Please describe your current capacity, skills, readiness, and/or anticipated support system to navigate through a potentially emotionally/psychologically challenging experience.
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Is there anything else you would like us to be aware of or any specific questions you have?

Thank you for your patience as our team reviews your submission and will get back to you in 5-7 business days after submission. Please note that applying does not guarantee acceptance. If you are traveling for this offering, please wait for confirmation of acceptance before booking logistics/accommodations.

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