Intake Form

Contraindication and Substance Guideline Understanding and Agreement

Please review the below information carefully.

Things that should be avoided before Kambo.

Mixing Kambo with any of the following could be extremely dangerous.

Immune suppressants
Slimming or sleeping supplements (including melatonin)
Alcohol or drugs 24 hours before and after Kambo
No salt diet (Ayahuasca diet)
Do not fast longer than 18 hours 7 days before or after Kambo. This includes juice fasting. Clients should have a normal eating pattern leading up to Kambo.
Sweat lodges, Colonics, enemas, liver flushes or any water-based detox should be avoided within 3 days before and after Kambo

Contraindications

Kambo is very safe when given by a properly trained practitioner however there are some conditions for which Kambo is contraindicated. You should not participate in a Kambo treatment if any of the following apply.

Have serious heart problems
Are on a no-salt diet (Ayahuasca diet)
Have Ehlers Danlos
Have Marfan syndrome
Are on medication for low blood pressure
Have had a stroke
Have had a brain hemorrhage
Have an aneurism or blood clots
Lack the mental capacity to make the decision to take Kambo
Have serious mental health problems excluding depression, PTSD, and anxiety
Are undergoing chemotherapy, radiotherapy, or for 6 weeks afterward
Take immune-suppressants for an organ transplant.
Have Addison’s Disease
Have current and severe Epilepsy
Are recovering from a major surgical procedure
Are under 18 years old
Have undergone a Bufo ceremony in the past 6 weeks
Are pregnant or maybe so or are breast-feeding
Taking a daily diuretic. If you are on medication that is also a diuretic but is not required to be taken daily, check with your practitioner to see if Kambo is safe for you
Person has consumed other strong medicines (San Pedro, Ayahuasca, Mushrooms) within 24 hours of wanting to receive Kambo
Person has reached their 70th birthday
Person has consumed large amounts of water prior to arriving for Kambo
Person has been fasting for longer than 18 hours
Person has received the Covid vaccine in the last 4 weeks

First and foremost, thank you for being open and willing to experience the beautiful Amazonian medicine of Kambo!

Please fill out the below questions in as much detail as possible. The more information, the better as it allows me to be fully informed and provide you with the best care possible. If a question does not apply to you, please put N/A.

What is it that interests you about Kambo?

Is there anything specific you are looking for support on?

Please list all prescription medications you are taking. Including the amount, how often and how long you've been taking them.

Please list all non-prescription medications you are taking. Including vitamins, herbal supplements, sleep aids, Kratom, laxatives etc

Do you have any allergies?

Please list any previous hospitalizations and/or surgeris.

Do you have a history of bulimia, injury to the esophagus from endoscopy, tumors or ulcers in the throat, or any other esophagus or neck related conditions or injuries?

Do you have any other medical history, mental illness, traumatic circumstances or concerns you feel should be mentioned so I can better support you?

Lastly, do you have any questions that you would like answered prior to booking?

Thanks for submitting! You will receive a response within 3 days. If you do not hear back, please email kambomanitoba@gmail.com directly.

Kambo Manitoba

Contraindication and Substance Guideline Understanding and Agreement

Please review the below information carefully. ​ Things that should be avoided before Kambo. Mixing Kambo with any of the following could be extremely dangerous. ​

Immune suppressants

Slimming or sleeping supplements (including melatonin)

Alcohol or drugs 24 hours before and after Kambo

No salt diet (Ayahuasca diet)

Do not fast longer than 18 hours 7 days before or after Kambo. This includes juice fasting. Clients should have a normal eating pattern leading up to Kambo.

Sweat lodges, Colonics, enemas, liver flushes or any water-based detox should be avoided within 3 days before and after Kambo

​ Contraindications ​ Kambo is very safe when given by a properly trained practitioner however there are some conditions for which Kambo is contraindicated. You should not participate in a Kambo treatment if any of the following apply. ​

Have serious heart problems

Are on a no-salt diet (Ayahuasca diet)

Have Ehlers Danlos

Have Marfan syndrome

Are on medication for low blood pressure

Have had a stroke

Have had a brain hemorrhage

Have an aneurism or blood clots

Lack the mental capacity to make the decision to take Kambo

Have serious mental health problems excluding depression, PTSD, and anxiety

Are undergoing chemotherapy, radiotherapy, or for 6 weeks afterward

Take immune-suppressants for an organ transplant.

Have Addison’s Disease

Have current and severe Epilepsy

Are recovering from a major surgical procedure

Are under 18 years old

Have undergone a Bufo ceremony in the past 6 weeks

Are pregnant or maybe so or are breast-feeding

Taking a daily diuretic. If you are on medication that is also a diuretic but is not required to be taken daily, check with your practitioner to see if Kambo is safe for you

Person has consumed other strong medicines (San Pedro, Ayahuasca, Mushrooms) within 24 hours of wanting to receive Kambo

Person has reached their 70th birthday

Person has consumed large amounts of water prior to arriving for Kambo

Person has been fasting for longer than 18 hours

Person has received the Covid vaccine in the last 4 weeks

Intake Form

Please review the below information carefully.

Things that should be avoided before Kambo.

Mixing Kambo with any of the following could be extremely dangerous.

Contraindications

Kambo is very safe when given by a properly trained practitioner however there are some conditions for which Kambo is contraindicated. You should not participate in a Kambo treatment if any of the following apply.