Kambo Waiver

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NameFull Name
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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Have you ever used Kambo before?* This field is required.
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The following must be avoided before Kambo. Please read carefully. Mixing Kambo with any of the following can be extremely dangerous: * This field is required.By clicking, “I agree”, you are agreeing that you have read the above regarding what should be avoided before Kambo and that you understand the dangers involved should you choose to neglect the above.
I agreeI do not agree
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Kambo does not generally have unintended adverse effects when administered by a properly trained practitioner and when clients have disclosed any underlying health conditions. You should absolutely not participate in a Kambo ceremony if any of the following apply: - By clicking, “I agree”, you are agreeing that you have read the above regarding contraindications of Kambo and that you understand the dangers involved should you choose to neglect the above.
I agreeI do not agree
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Is there anything else you'd like me to know?
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Substance Guideline List The following substances should be abstained from before and after a Kambo session. Please confirm your agreement to each abstinence period: Substance / Minimum Abstinence Before Kambo / Post Kambo [ ] Alcohol (High Doses): 48 Hours / 7 Days [ ] Alcohol (Low Doses): 12 Hours / 24 Hours [ ] Amphetamines (Adderall, Ritalin): 7 Days / 7 Days [ ] Anti-Convulsants: Must discuss with facilitator [ ] Anti-Psychotics: Contraindicated [ ] Ayahuasca & Analogues: 24 Hours / 24 Hours [ ] Benzodiazepines (Valium, Diazepam): 18 Hours / 8 Hours [ ] Beta Blockers: Do not take morning of treatment / 8 Hours [ ] Blood Thinners: Do not take morning of treatment / 8 Hours [ ] Botox: 7 Days / 7 Days [ ] Bufo: 24 hours / 6 weeks [ ] Cannabis: 12 Hours / 24 Hours [ ] Cocaine: 3 Days / 5 Days [ ] Codeine: 24 Hours / 24 Hours [ ] Crack Cocaine: 7 Days / 7 Days [ ] DMT: 24 hours / 24 hours [ ] Ecstasy (MDMA): 7 Days / 7 Days [ ] Fentanyl: Contraindicated [ ] GHB: 7 Days / 7 Days [ ] Heroin: 14 Days / 14 Days [ ] Iboga: 90 days / 24 Hours [ ] Ibogaine: 10 days / 24 Hours [ ] Ketamine: 3 Days / 3 Days [ ] Mescaline: 24 hours / 24 hours [ ] Meth Amphetamine: 30 Days / 30 Days [ ] Morphine/Oxycodone: 5 Days / 5 Days [ ] LSD: 48 Hours / 72 Hours [ ] Psilocybin: 24 Hours / 24 Hours [ ] Tramadol: 48 Hours / 24 Hours [ ] Vasoconstrictors (Triptans): 3 Days / 12 Hours [ ] Covid Vaccine: 30 Days / 7 Days V. Liability Release and Assumption of Risk
I agree
Alcohol (High Doses): 48 Hours / 7 Days
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Alchohol (Low Doses) 12 hours / 24 hours
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Amphetamines (Adderall, Ritalin): 7 Days / 7 Days
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Alcohol (High Doses): 48 Hours / 7 Days
Alchohol (Low Doses) 12 hours / 24 hours
Amphetamines (Adderall, Ritalin): 7 Days / 7 Days
I agree
Row 0, Column 0
I agree
Row 1, Column 0
I agree
Row 2, Column 0
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