Kambo Form

Kambo

Application For Kambo Ceremony

1Mandatory Reading

2Personal Information

3Contraindications

4Helping us help you

5Submit

While there are many anecdotal stories about physical, emotional and spiritual healings occurring after a Kambo session, and lots of medical research done into the 200 specific peptides found in the Kambo secretion and their effects, the Kambo sessions offered here are not offered as a medical treatment, and are not a substitute for any other medical treatment you may be undergoing or considering undergoing. The sessions are offered as an insight into, or an experience of an ancient traditional Amazonian ritual used in various ways for centuries by the indigenous peoples of the rainforest, who consider the Kambo frog to be a holy animal who can offer well-being, positive energy and wisdom to one who receives it with respect.

Kambo helps the body to help itself. Kambo may provide spiritual and physical support, purge negative energies and help the immune system. If you have any doubt about the compatibility of Kambo with any existing medical treatments which you are following, you should consult with your GP or other medical practitioner. The main known contraindications are covered in the first section of the questionnaire. It is essential that you answer honestly so we can properly assess whether we feel happy to invite you to participate. By your attending this session, you will receive a series of tiny burns on your skin which may or may not disappear completely. (Advice will be offered as to how to assist in this respect so as to minimise this), and we always offer a choice of where the points go.

It is important to take responsibility for the messages the Spirit of Kambo shares with you during and after these sessions. The effect of Kambo can be strong and can bring about deep emotional and physical processes for some days after the session. Please coming willing to take full responsibility for your feelings, emotions, and the physical discomfort which may be brought to the surface during and after the session. Kambo can provide a useful mirror to reflect positive and shadow aspects of yourself.

Have you read and understood the text above?(Required)

Yes

Name(Required)

First Last

Email(Required)

Phone(Required)

Your Age(Required)

You must be over 18!

Name of a spouse, friend or family member and your relationship to them(Required)

eg Mary Jones, Wife.

Mobile number of a spouse, family member or close friend.(Required)

Have you got any dietary restrictions?(Required)

Yes

Please tell us what are your dietary restrictions(Required)

Have you experienced Kambo before?(Required)

Yes

Are you familiar with spiritual ceremonies?(Required)

Yes

Which ones have you done before?(Required)

These are the specifically contraindicated conditions which would preclude you from participating in the ceremonies. Please confirm the following, elaborate as required.

Do you have or have you had any heart problems?(Required)

Yes

Have you had a stroke?(Required)

Yes

Have you had a brain haemorrhage?(Required)

Yes

Have you had any aneurisms or blood clots?(Required)

Yes

Have you had any serious mental health problems EXCLUDING depression, PTSD and anxiety?(Required)

Yes

Are you undergoing chemotherapy or radiotherapy or have you within 4 weeks?(Required)

Yes

Do you take immune-suppressants?(Required)

Yes

Do you have Addison’s Disease?(Required)

Yes

Do you have current Epilepsy?(Required)

Yes

Are you recovering from a major surgical procedure?(Required)

Yes

Are you pregnant (or is it possible you may be) or are breast-feeding a child under 6 months old?(Required)

Yes

Do you have Lyme disease?(Required)

Yes

During some of the sessions, we will be using the Chinese meridian system to direct the energy of the Kambo. These questions are to help us understand a little bit more about your energetic system and any energetic tendencies you may have.

Please describe any physical health issues you have presently or serious ones from the past. Especially concerning: epilepsy, heart, kidneys or other major organs.(Required)

Please tell us about any minor physical health issues that are current for you now or persistent ones from your past.(Required)

Are you Bulimic or have you ever experienced Bulimia in the past?(Required)

Yes

Please elaborate.(Required)

Do you have any past or current eating disorders?(Required)

Yes

Please specify.(Required)

Do you have any physical health issues that run in your family?(Required)

Yes

Please describe.(Required)

Are you taking any prescription or alternative medicines now?(Required)

Yes

Which ones?(Required)

Have you recently taken (within the last year) any prescription or alternative medicines, or taken any long courses in the past?(Required)

Yes

Which ones?(Required)

Please describe any mental health issues you have presently or have had in the past. Especially schizophrenia or depression.(Required)

Are there any mental health issues that run in your family?(Required)

Yes

Do you have any addictions?(Required)

Yes

If so what to? Describe your current usage.(Required)

What is your blood pressure? (Don't worry if you don't know as I will be able to take a reading before the session)(Required)

Would you say you are a warm or cold person, physically (i.e. do you tend to get cold before everyone else?(Required)

Warm Person

Cold Person

Would you say you get tired easily?(Required)

Yes

Please describe how well you sleep – how long, how easily etc.(Required)

Are you prone to Constipation?(Required)

Yes

How many Bowel movements do you have per day?(Required)

How many Bowel movements do you have per week?

Have you had Botox in the last 7 days?(Required)

Yes

Have you recently had COVID19?(Required)

Do you currently have COVID19?(Required)

Have you received the COVID19 vaccine?(Required)

Wich one?(Required)

When(Required)

MM slash DD slash YYYY

If yes to any of the above please elaborate.

A clear idea of what you want from the experience can significantly enhance the possibility of receiving it. If you have an intention for the session, please state it here:(Required)

Thank you for persevering with a long form. It will help to maximise the experience. I'm excited to be able to offer this incredible gift from Mother Amazon to you soon. Malcolm

Kambo

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Kambo

About The International Wellness Farm

Retreats

Wellness Farm

Join our Community

what’s happening at International Wellness Farm

Let’s Get Juicing!

Support your Body Naturally with every sip

Upgrade your health

Cart

Support your Body
Naturally with every sip

Upgrade
your health