KAMBO INQUIRY FORM

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KAMBO INQUIRY FORM

Welcome! It is so exciting you have made it here! Please take some time to fill out the form below to ensure a Kambo ceremony is in alignment for where you are in life right now. All Kambo ceremonies include energy work, post ceremony coconut water/fruit, a preparation consult and an integrative consultation.

Once your application is submitted, I will reach out to set a time to chat to discuss if Kambo is in alignment for you and if so, what your protocol can look like (ex; only one sit, sit once then month two sit in a back to back ceremony, etc)

I look forward to supporting you on this journey !

Thank you <3
In love and light,
Patricia

Email *

Name *

Phone Number ( I will text to set up our consultation call) *

Email (in case I cannot reach you by text / to send important Kambo information) *

What interests you in sitting with Kambo? *

Have you ever sat with Kambo before? *

yes

If so, what was/have your experiences been like? (type N/A if you have not experienced Kambo yet) *

Please check all that apply. I am experiencing: *

Seizures / Aneurisms / Blood Clots

Are pregnant, may be pregnant, or breastfeeding

Elher's Danlos Syndrom

Addison's Disease

Heart Disease / Pace Maker

On medication for Low Blood Pressure

Bipolar

Schizophrenia

Mental Illness Diagnosis not listed

Within 6 weeks of working with chemotherapy or radiation treatment

Take immunosuppressants for organ transplant

Recovering from a major surgical procedure

Have taken Bufo or 5-MeO-DMT within 6 weeks

Difficult time deciding if Kambo is right for me

Low Blood Pressure

None of the above

Other:

Required

Please check all that apply. The following are part of my life: *

Diet and / or sleeping pills

Anxiety and/or Fear and/or Depression

Active drug or alcohol addiction

Fasting for long periods of time

Colonics, Enemas, liver flushes

none of the above

Required

Please list if you are applying for:

One Dot Sundays at Good Medicine Spa: $140 p/p

FIRST Private Ceremony for yourself: $355 p/p (consultations included, $285 after first session)

Private Group Ceremony ($$ ranges depending on group size)

Do you have any questions or concerns? *

Submit

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