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Kambô Intake Form

Thank you so much for your interest in Kambo. In order to participate in a Kambo ceremony, you'll need to be approved as a good candidate. Once you've filled out and submitted this form, I will contact you via email within 24 hours. Once you are approved and the ceremony is scheduled, you will then be able to make a purchase on my website. 50% payment is due at the time of scheduling and 50% is due on or before the ceremony. 

Group ceremonies are held on these dates. Choose the best date that works for you.

Tell me why you would like to work with kambo. 

Which offering(s) are you interested in?
Do you have, or have ou had, any of the following? Mark ALL that apply.


Medications that are NOT compatible with Kambô include:

  • Parkinson’s medications

  • Heart disease medications

  • Epilepsy medications

  • Lyme's Disease medications (in some cases)

  • Blood pressure medications

  • Steroids (Arthritis + Rheumatism) medications

  • Corticosteroids medications

  • Infection (Diclofenac) medications

  • Sleeping pills/ medications

  • Varicose Vein medications

  • NSAID medications

  • Clove and other cleansing herbs


List of conditions that CANNOT be safely taken with Kambô:

  • Heart problems (of any and all kinds; this includes having a pacemaker

  • Stroke or Brain hemorrhage

  • Aneurysms or blood clots

  • Are recovering from a major surgical procedure with internal stitches

  • Schizophrenia or severe psychosis

  • Chemotherapy or radiotherapy (for at least 4-6 weeks afterwards)

  • Organ transplants (cannot be taken with immune suppressants)

  • Severe immune system disorders like MS or ALS

  • Pregnancy or breastfeeding a child under 6 months old

  • Addison’s disease

  • Hyper- and hypotension

  • Certain types of EDS

  • Epilepsy

  • Under 18 years of age

Upload File

Please click below to download the Waiver and Release of Liability form. Read through it carefully, initial and sign where indicated, and upload the file below. 

You will receive a response within 24 hours. Thank you!

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