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Hummingbird Center Booking Form

Thank you for applying for an ayahuasca retreat at the Hummingbird Center! To begin our registration process, please fill out this form, and we will try to get back to you within 24 hours with any follow up questions we may have.

All information provided will be kept private and confidential.

For your own safety is is important the medical background information be truthful and accurate. With certain conditions, medications or recreational drugs, there are serious risks, with the worse case being death. Please be honest and complete, and do not take a chance with your health and safety. Be sure to have read our Ayahuasca Safety page.


Have you ever or are you currently suffering from any of the following conditions?
Asthma
Diabetes
Cancer
Bipolar disorder
Mental Illness
Schizophrenia
Anxiety
Depression
PTSD
IBS
High blood pressure
Low blood pressure