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Informed Consent Form

Introduction:

Thank you for your interest in participating in our cacao ceremony/therapy session. Before you proceed, please read and understand the following information. This form is designed to ensure that you are fully informed about the ceremony and its potential effects.

Purpose of the Ceremony:

The cacao ceremony is a sacred gathering designed to facilitate personal growth, healing, and spiritual connection. Participants consume ceremonial-grade cacao as a tool for inner exploration, meditation, and intention setting. The facilitator is a hypnotherapist and energy healer and will do her best to help you achieve your goals with this unique type of therapy session.

Benefits:

  • Enhanced mindfulness and presence

  • Emotional release and healing

  • Increased creativity and insight

  • Connection with oneself and others

  • Spiritual exploration and growth

Risks:

While the cacao used in the ceremony is safe for consumption, it does contain caffeine and other compounds that may affect individuals differently. Some potential risks include:

  • Allergic reactions: Although rare, some individuals may be allergic to cacao.

  • Sensitivity: Cacao can amplify emotions and sensations, which may be overwhelming

    for some individuals.

  • Interactions: Cacao may interact with certain medications or conditions. Please inform

    the facilitator if you have any medical concerns or are taking any medications.

Participant Responsibilities:

By participating in the cacao ceremony, you agree to:Consume cacao responsibly and in moderation.

  • Respect the ceremonial space, including other participants and facilitators.

  • Honor the guidelines provided by the facilitator.

  • Take responsibility for your own well-being and emotional experience.

Confidentiality:

Participants are encouraged to maintain confidentiality regarding personal experiences shared during the ceremony. This helps to create a safe and supportive space for everyone involved.

Voluntary Participation:

Participation in the cacao ceremony is voluntary, and you have the right to withdraw at any time without consequence.

Birthday

Health Status:

Do you have any known illnesses?
Yes
No
Are you currently taking any medication?
Yes
No
Cardiovascular Issues: - Have you ever had a heart condition?
Yes
No
Have you ever had high blood pressure?
Yes
No
Have you ever had a circulatory disorder? (e.g., anemia, thrombosis)
Yes
No
Have you ever had any respiratory problems? (e.g., asthma, chronic bronchitis)
Yes
No
Do you suffer from any muscle or skeletal issues? (e.g., arthritis, chronic pain)
Yes
No
Do you suffer from any digestive problems? (e.g., stomach ulcers, irritable bowel syndrome)
Yes
No
Allergies: - Do you have any allergies?
Yes
No
Mental Health: Do you have any known mental health conditions?
Yes
No
Are you currently taking any psychiatric medication?
Yes
No
Have you ever had a panic attack?
Yes
No
Do you have any other health issues we should be aware of?
Yes
No

Possible Effects and Consequences:

During the cacao ceremony, you may experience various effects, including but not limited to:

  • Increased emotional sensitivity

  • Deep internal insights and emotional release

  • Physical reactions such as heart palpitations, sweating, or mild dizziness

  • Deeper connection with yourself and others

  • Feelings of calmness and peace

  • In rare cases, panic or anxiety It is important to understand that these effects can vary from person to person, and not everyone will experience the same.

Disclaimer:

I declare that the above information is true to the best of my knowledge. I am fully aware of the possible effects and consequences of the cacao ceremony. I participate in the ceremony of my own free will and volition. I understand that the organizers are not liable for any health issues or adverse consequences that may arise. I accept that my participation is voluntary and at my own risk, and I will not pursue any legal claims against the organizers for any harm or damage incurred during or as a result of the ceremony.

Date

About your facilitator: Gabriella Davidovics

I am a CNHC - registered Solution Focused Psychotherapist and Clinical Hypnotherapist accredited by the CPHT, a registered member of the Association for Solution-Focused Hypnotherapy (AfSFH), and the National Board for Modern Psychotherapy (NBfMP). I hold the Hypnotherapy Practitioners Diploma(HPD) and member of the National Council for Hypnotherapy (NCH).

Further qualifications:

  • Reiki Master and Teacher

  • NLP Practitioner

  • IEMT Practitioner

  • Past Life Regression Practitioner

  • Ceremony Facilitator

  • Temple Of Body Awakening Practitioner

  • Massage Therapist (Lymphatic massage, Maderotherapy, Samun Prai Massage, Tibetan-Russian Honey Massage)

  • Dzsuna Practitioner

  • Lifelong learner 😊

Non–Therapy Qualifications and Background:

Masters Degree - Economist in Tourism and Management (Budapest Metropolitan University)

BA Degree in Economics – Specialized in Event Management

Event Management in Top London Hotels

British Council – IELTS: Event Management, Assisting Head of Departments

Spoken Languages: Fluent in English, Native Hungarian, Intermediate French

British and Hungarian Citizen

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