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Personal Health & Wellbeing Questionnaire

Your wellbeing is our highest priority.

This form is an essential part of our application and preparation process. It helps us understand how to best support you — physically, emotionally, mentally, and spiritually — before, during, and after the journey.

Evolutionary Journeys takes place in a deeply immersive and transformative setting. Some of the practices and experiences involved may not be appropriate for everyone. By sharing honestly and transparently, you help us ensure that the container is safe, ethical, and supportive for you and for the entire group.

All information shared here is strictly confidential and will be reviewed only by the core facilitation team. Your responses do not automatically disqualify you from participation. In some cases, they may guide us toward additional conversations, preparation, or alternative recommendations that better serve your wellbeing.

Please take your time, answer with care, and trust that this process is here to honor your health, dignity, and readiness for the journey.

Have you ever in the past, or are you currently dealing with any of the following conditions

Autism Multiple Personality Disorder Schizophrenia Post-Traumatic Stress Disorder (PTSD) Panic attaks Borderline personality disorder Paranoia Bipolar disorder Suicidal thoughts Psychosis Obsessive Compulsive Disorder (OCD) Depression Psychotic breaks Eating disorder Depersonalization disorder

If you want to provide more details, please do so:

Have you ever suffered from back pain, spinal defects or spinal disorders?

Yes No

Have you ever suffered from headaches, migraines and/or neck pain?

Yes No

Have you ever had problems with your muscular system?

Yes No

Do you have any bone fractures?

Yes No

Did you or do you have any joint pathologies?

Yes No

Did you or do you suffer from osteoporosis?

Yes No

Have you ever suffered a stroke or heart attack, even a mildest one?

Yes No

Did you undergo a serious heart surgery?

Yes No

Do you suffer from any blood pressure condition?

Yes No

Do you suffer from anxiety and/or depression?

Yes No

Do you suffer from insomnia?

Yes No

Have you ever taken non-prescribed drugs?

Yes No

Have you taken any prescribed medications within the last 12 months?

Yes No

Do you have any infections or viruses?

Yes No

Have you or any of your family members suffered from mental disorders?

Yes No

Do you have any physical disabilities or limitations?

Yes No

Have you ever had any surgical intervention or any body part replaced with a prosthetic limb?

Yes No

Do you have any allergies?

Yes No

Are you allergic to any medications?

Yes No

Do you have any special dietary requirements?

Yes No

What is the nature of your daily activities?

Do you practice any sports or physical training regularly?

Yes No

Do you have any type of spiritual practice in your daily life?

Yes No

Do you express yourself through some creative or artistic way?

Yes No

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