Add your details

First name

Last name

Phone Number

How did you hear about this ceremony?

Have you Received Kambo before?

My First Time

I have received kambo before

When was the last time you received Kambo?

How many Gates/Points did you receive during your last Kambo ceremony?

What brings you to this Kambo ceremony?

Is there anything you are currently working through that you would like support with?

What would you like to release, shift, or create space for?

Is there anything you would like your facilitator to be aware of regarding your emotional or spiritual experience?

Have you had any recent surgeries, hospitalizations, or significant medical procedures? IF YES PLEASE SHARE

Do you have any known heart or cardiovascular conditions?

Is there anything else about your physical or mental health that you believe is important for the facilitator to know?

Are you currently taking any pharmaceuticals or herbal supplements? If so, please list them.

Do you have high or low blood pressure? If so, are you taking medication?

Are you currently pregnant or breastfeeding?

Yes

KAMBO GROUP CEREMONY

Nov 28, 2026, 9:00 AM – 1:00 PMPRIVATE HEALING STUDIO