A moment of reflection to ensure this path is the right one for you at this time.

Stepping Into Ceremony

Intake Form

First name

Last name

Pronouns

Phone

Address

Have you ever attended a Bufo ceremony before?

YES

Are you interested in a private session or group ceremony?

YES

What are your current life challenges?

Do you have any history of heart conditions, high blood pressure, seizures, stroke, or fainting?

YES

Have you ever experienced asthma, respiratory issues, or difficulty breathing?

YES

Are you currently pregnant or trying to become pregnant?

YES

Do you have any neurological conditions or history of traumatic brain injury?

YES

Have you had surgery or major medical procedures in the past year?

YES

Are you currently under the care of a physician for any ongoing health concerns?

YES

Are you currently taking any prescription medications? (especially SSRIs, MAOIs, benzodiazepines, antipsychotics, or mood stabilizers)

YES

Have you used ketamine, MDMA, or similar substances within the last 30 days?

YES

Do you regularly use alcohol, cannabis, or other substances?

YES

Have you used any psychedelics or entheogen in the past? If so, how was that experience for you?

YES

Are you currently experiencing depression, emotional instability, or thoughts of self-harm?

YES

Have you ever been diagnosed with bipolar disorder, schizophrenia, psychosis, or experienced manic or dissociative episodes?

YES

Have you had severe anxiety, panic attacks, or PTSD symptoms in the past year?

YES

Are you currently in therapy or receiving mental health support?

YES

Do you experience the world in ways that feel especially sensitive, unique, or non-linear (sensory, emotional, or cognitive)?

YES

Are there certain environments, sounds, touch, or forms of stimulation that feel overwhelming or require extra care?

YES

Meditation, consciousness-altering states, or shamanic retreats?

YES

Trauma in CHILDHOOD?

YES

Significant losses or grief?

YES

Trauma as an ADULT?

YES

Is there any area where your support network is lacking?

YES

Does your immediate family support your having this experience?

YES

What would you like to gain from this experience?

What is your occupation?

What are your hobbies/interests?

Who are the most important people in your support network (friends, family, spiritual leaders or community, therapists, etc)?

Are you serving or have you served in any branch of the armed forces of the United States?

Are you currently or have you ever been a first responder (peace officer, highway patrol, firefighter, EMT, paramedic, emergency room medical staff, disaster relief worker, social worker, public safety dispatcher)

In what time frame are you looking to attend ceremony?

Thank you for taking the time to answer these questions with honesty and care. Your responses help us ensure a safe, respectful, and supportive experience for everyone involved. We will review your submission thoughtfully and be in touch soon.

Thank you for completing the intake form.

Thank you for completing the intake form. The following waiver helps ensure clarity, consent, and shared understanding as we move forward together. Please read it carefully before signing.

Waiver Form