Kambo Explore Form

1

NameFull Name

First Name

Last Name

2

Email

example@example.com

3

Phone Number

Please enter a valid phone number.

4

Have you ever used Kambo before?

5

What do you hope to achieve with Kambo?

6

Do you have any difficulties with the heart, liver or kidneys?

7

Are you currently on any medications?

8

Do you have any chronic illnesses, autoimmune, mental health or other health concerns or conditions?

9

Are you able to fast for 8 hours and hydrate before ceremony?

10

Are you able to be available in the morning to mid-day for ceremony? Are you able to set time aside for at least 2 hours free of interruption? Ceremonies are conducted at homes and pets and children should be taken into consideration.

11

Is there anything else you'd like me to know?

12

By signing this form, you attest that everything submitted is true to the best of your ability. You understand that honesty is necessary as working with Kambo may have serious complications if certain circumstances aren't met. You understand that Kambo is not facilitated by a doctor, is not a medical practice, treatment or procedure and does not replace medical care.Your signature confirms your understanding and agreement that research is your responsibility, and the kambo ceremony is elective. Testimonials and transformations are anecdotal and bio-individual.

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