WELCOME TO YOUR
IMMERSIVE JOURNEY

Date

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

Country

(###)

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Name *

First Name

Last Name

Phone *

Country

(###)

###

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Do you have any of the following conditions? Please check all that apply:

Heart Disease

High or Low Blood Pressure

Stroke

Epilepsy

Diabetes

Autoimmune Disease

Organ Transplant

Kidney Stones

Liver Disease

Cancer

Mental Health Disorders (e.g., Depression, Anxiety, Bipolar Disorder)

Pregnant or Breastfeeding

Recent Surgeries (within the last 6 months)

Allergies (medications, foods, etc.)

By following these preparation guidelines, the body and mind will be in optimal condition to receive the full benefits of the Kambo ceremony. Please review and confirm the following points: *

I understand that Kambo is a traditional practice, and its effects may vary.

I understand that Kambo induces strong physical reactions, including purging (vomiting, sweating, bowel movements).

I have disclosed any and all medical conditions and medications accurately.

I understand the need to follow dietary restrictions and preparation guidelines.

I will refrain from using alcohol, recreational drugs, or tobacco 48 hours before the ceremony.

I acknowledge that Kambo is not intended to replace medical treatment and does not claim to cure any diseases.