IXCHEL
IXCHELSpiritual Clinic
← Return
⟡ Intake Form

Welcome & introduction.

Before participating in any ceremony or retreat, everyone is required to complete a confidential medical intake form. This form helps us understand your current physical, emotional, psychological, and spiritual health so we can best support your safety, comfort, and dignity.

Please answer all questions honestly and thoroughly. All information is kept strictly confidential and is used solely to assess your readiness for the work.

Certain conditions or medications may require further discussion, a delay in participation, or referral to another type of support.

Completing this form is an act of self-respect and responsibility. Thank you for helping us hold this work with the care it deserves.

Begin the FormConfidential · Held with care