Health screeningParticipant form

Before you begin

Health screening

A guided questionnaire, with room to answer in your own words.

Allow about 20–30 minutes and have your medication list and emergency contact information ready.

Submitting this form is not medical clearance or acceptance into a ceremony. Do not stop or change medication to qualify.
How your information is handled

When you submit, the website processes your answers and signature temporarily in memory, creates a PDF, and sends it to admin@sufiyasanctuary.org through the configured email provider. We do not save your submission in a website database or use browser local storage. The email provider and the Sanctuary’s mailbox may retain the message, attachment and delivery records. Hosting and email infrastructure may also retain technical logs; this form does not log answer contents. Email is not end-to-end encrypted by this form, and confidentiality cannot be guaranteed. Your PDF becomes a Sanctuary screening or participation record under the agreement. For another submission method, contact the Sanctuary before entering sensitive details.

Closing or refreshing the page loses unfinished answers. There is no saved draft or resume link. You can download the completed PDF in this session after confirmed email-service acceptance.

Adults 21+ · Your pace · No medication changes to attend