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Kambo Client Care Form

Emergency Contact:

Do you suffer from any of the following?

Serious heart problems YesNo

Medicated low blood pressure YesNo

Abnormally high or low blood pressure YesNo

Stroke, brain hemorrhage, aneurysm, blood clots YesNo

Lack the mental capacity to make the decision to take Kambo YesNo

Serious mental health problems YesNo

Undergoing or have been undergoing chemotherapy or radiotherapy YesNo

Taking immunosuppressants for an organ transplant YesNo

Addison’s Disease YesNo

Current and severe epilepsy YesNo

Recovering from a major surgical procedure YesNo

Taking immunosuppressants for autoimmune disorder YesNo

Serious eating disorder e.g. Bulimia or Anorexia YesNo

Active drug addiction YesNo

Take regular high doses of slimming, serotonin and/or sleeping supplements YesNo

Fasted for more than a few days before Kambo YesNo

Liver or Kidney problems YesNo

Asthma YesNo

Diabetes YesNo

Regularly consume diuretic medications or sports drinks YesNo

Have you participated in a Bufo ceremony in the last 8 weeks YesNo

Females only:

Are you pregnant or are you breastfeeding a child under 6 months old YesNo

Undergoing fertility treatment YesNo

First day of your last cycle:

Other considerations:

We strongly advise against enemas, colonics, liver flushes, or any water based detoxes within 5-7 days before and after taking Kambo
We also strongly advise that you DO NOT consume more than 2.5 liters of water during a single treatment (including 2 hours before and after the Kambo session)
People with asthma need to bring their inhaler with them to the Kambo session
Diabetics need to bring insulin, testing strips, and extra food
Menstruation flow may increase 24-36 hours following the Kambo treatment
It is completely safe to continue to take any other medication, however please discuss this beforehand

Disclaimer:

I understand that Kambo International practitioners are not medical doctors, nor any other form of medical practitioner.

I understand that Kambo International practitioners do not diagnose disease, offer health advice, treat physical or mental health issues, or prescribe medicine or pharmaceuticals.

I understand that any complementary therapy treatment which I receive is not a substitute for a medical or psychological diagnosis or treatment by a qualified medical practitioner.

I understand that it is recommended that I see such a practitioner for any physical or psychological problem I have now or in the future.

I confirm that I have read and understand the list of contraindications provided and agree that I do not have any conditions that would contraindicate me from taking Kambo.

I further confirm that all the details provided are true and accurate.

I hereby release Kristine Ovsepian and Journeys to Heal from any and all liability resulting from the use of equipment, materials, preparations, remedies, or treatments and assume full responsibility for all risks regarding this treatment.

I confirm that I am of lawful age and fully understand the contents of this document.

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December 13, 2024 2:13 pm PST

Kambo Client Care Form Uploaded by Kristine Ovsepian - kristine@journeystoheal.com IP 97.107.177.135