Temazcal Form – Marissa Abisai Ceja

Dear Meg,

Thank you for participating in this questionnaire for the upcoming Temazcal ceremony.
Your responses will assist us in creating a meaningful and personalized experience for you.

Please answer the following:

Personal Information:

Full name *

Date of birth *

Place of birth *

Email *

Country *

Place of residence *

Civil status *

With children? *

Health:

Blood pressure *

Normal
Low
High

Rheumatism *

Thyroid *

Allergies *

Intolerances *

Chronic conditions *

Ailments *

Cysts *

Hemorrhoids *

Menopause *

Symptoms *

Cancer *

Diabetes *

Abortion(s) *

Diet *

Chicken
Fish
Meat

How many hours a day do you sleep? *

How much water or liquids do you drink a day? *

Birth

What do you know about your birth? *

Intentions

Why do you want to participate in the Temazcal ceremony? *

Additional Information

Is there anything else you want to add or mention? *

Personal Information:

Health:

Birth

Intentions

Additional Information

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