TRAUMA INFORMED
QUESTIONNAIRE
Thank you for filling out this questionnaire. By doing so, you will be helping us to collect valuable data about how ayahuasca affects people over time. This, in turn, will lead to a better understanding of how this medicine might help more people more effectively.
The questions have been taken from standardized self-assessment surveys already used by healthcare providers and all answers are selected from simple number scales (0 - 4). This allows for results to be compared over time and for people from all walks of life.
In addition to taking the survey once before your retreat, we will ask you to take it a few more times in the year that follows. Participation is optional and your name will never be shared with anyone. Allow this process to serve as a tool of reflection, an opportunity to check in with yourself about how you have been feeling lately.
There are two sections of the questionnaire, each with its own short instructions, questions, and answer scale.