Initial Assessment and Health Overview

  • Initial Assessment and Health Overview

    To ensure that you have the best possible experience during your session, we would like to have some more information about your medical history, medication and any supplements. The information you provide will help us determine the appropriate dosage of the medicine and assess whether it is safe for you to undergo a journey. It is crucial that you provide this information honestly and in its entirety. Failing to do so can significantly impact your journey, overall well-being and even your life. Please inform us if you have ever experienced or are currently dealing with a physical or mental health condition, regardless of whether or not you are taking medication for it. In most cases, it is usually safe for you to continue your normal medication, but it's important to discuss this with us beforehand. By providing us with accurate and complete information, you allow us to ensure your safety and maximize the benefits of your experience.
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  • Format: (000) 000-0000.

  • Session Information

  • Please state which teachers you are hoping to work with:

  • Kambo

    Kambo is a powerful medicine works deeply and needs to be respected so that we can tailor your experience to meet your needs. Rest assured that all information you provide is confidential, and any behaviours or recreational drug use will not be judged but rather taken into consideration during the treatment. We need a comprehensive overview of your health and well-being before proceeding. Please note that Kambo is entirely safe when administered by a properly trained practitioner. We are fully Certified Advanced Kambo Practitioners under the IAKP (International Association of Kambo Practitioners). You can find more information about this organization at www.IAKP.org. If you are menstruating at the time of treatment, please be aware that Kambo may potentially increase the flow for 24-36 hours due to its powerful vasodilators. If you have asthma, it is essential to have your inhaler with you during the session. If you have diabetes, it's important to discuss your treatment in advance. If you have been engaged in long-term water fasting, especially leading up to the treatment, it is crucial that you inform us.

  • Sacred Teachers

    There is a psychedelic compound in mushrooms that affects serotonin receptors in the brain, leading to positive changes in perception, thoughts, and mood. There is a lot of research being carried out now that suggests that taking mushrooms can have positive effects on wellbeing. Some of the potential positive effects include: • Reduced symptoms of depression and anxiety. • Increased psychological well-being • Enhanced emotional openness and empathy • Alleviation of existential distress • Positive behaviour change

  • Grandmother

    Grandmother sessions are intended to be a personal growth experience and should not be considered a substitute for psychotherapy but a complementary therapeutic device. Working with grandmother can involve intense experiences accompanied by strong emotional and physical releases. It is not recommended for people with Cardiovascular problems, serious hypertension, psychiatric conditions, recent fractures or surgery, acute infectious diseases, epilepsy or active spiritual emergencies. There is no empirical research data on the safety of grandmother in pregnant women. If you have any doubt as to whether you should participate in the session, it is essential that you consult your doctor or therapist, as well as the organisers of the session. Please answer all questions as fully and honestly as possible. Withholding the truth from this application form could risk your safety and of others in the session.

  • Physical Health

    Please complete this health form as thoroughly as possible:
  • Considering your age, how would you describe your overall health?
  • Do you currently have any medical conditions?
  • If so, are you currently in the care of a health care professional?
  • Do you have a history or present condition of high or low blood pressure?
  • Please check for present or past conditions if not sure leave blank:
  • Please circle check for present or past conditions if not sure leave blank:

  • Kambo Specifically : Conditions of the Oesophagus

    Because Kambo can cause violent vomiting we need to have some caution around certain conditions that could weaken the Oesophagus/Esophagus. These do not necessarily preclude you from experiencing Kambo but it is advisable to make sure to let know if you have been affected with any of the following: 
  • Conditions of the Oesophagus
  • What allergic reactions have you had? Check all that apply:
  • Should be Empty: