OMS Ceremony & Medical Questionnaire OMS Ceremony Questionnaire Name * Email Phone City and State of Residency * Date of Birth * Religious Afilliation Christianity Islam Buddhism Judaism Kabbalism Scientology Atheist Universal Other If you selected "other" for your religious affiliation, tell us about it here. Our toughest excursion requires carrying about a 10-20lb pack on a 1 mile hike with the last 15 minutes being a very steep gradient, and on day two it requires a 2 mile hike with the last half mile going up a very steep gradient. Are you physically fit enough for this? If not, then you will be notified for less strenuous excursion is advised. Why do you want to attend an OMS ceremony? * Have you ever utilized Sacraments? If so, what have you utilized? * Do you have allergies to foods or medications? If so, list them here. * Do you have any medical conditions? If so, list them here. * Do you have any mental health conditions? If so, list them here. * Have you been hospitalized for a physical or mental illness in the past 24 months? If so, provide details here. * Are you currently suicidal, homicidal, or experiencing visual or auditory hallucinations? If so, provide details here. * Are you currently on medication? If so, list the medications and reason(s) why they were prescribed here. * This is very important, some sacraments such as Syrian Rue or Banisteriopsis Caapi cannot be combined with certain medications. If there is anything else you would like us to know, provide details here. reCAPTCHA
