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Kambo Waiver

To ensure your safety and well-being during the Kambo ceremony, I kindly ask that you complete a waiver beforehand. This form helps me understand your medical history and any potential concerns, allowing me to provide the best possible care and support throughout your experience. It is crucial that you provide this information honestly and in its entirety. Your cooperation in filling out the waiver is greatly appreciated and will help create a safe and nurturing environment for your transformative journey. 


Please fill out the following form.

Date of birth

Kambo is a profound healing medicine that works deeply, requiring careful respect to customize your experience according to your unique needs. Your privacy is of utmost importance, and all information shared with me remains strictly confidential and any behaviours or recreational drug use will not be judged but rather taken into consideration. Before proceeding, I kindly request a thorough overview of your health and well-being.

Please note that Kambo is entirely safe when administered by a properly trained practitioner. I am proud to be fully Certified Kambo Practitioner under the International Association of Kambo Practitioners (IAKP). For more details about this organization, you can visit

If you are menstruating during your session, please note that Kambo may temporarily increase flow for 24-36 hours due to its potent vasodilators. For those with asthma, it's important to have your inhaler on hand. If you have diabetes or have recently engaged in prolonged water fasting, please discuss your situation with us beforehand.

Do you currently have any medical conditions?
If you answered 'yes' to the previous question, are you currently in the care of a health care professional?
Do you have a history or present condition of high or low blood pressure?
Please select any present or past conditions if not sure leave blank:
Please select for present or past conditions if not sure leave blank:

Conditions of the Oesophagus:

Because Kambo can cause violent vomiting we need to have some caution around certain conditions that could weaken the Oesophagus/Esophagus. These do not necessarily preclude you from experiencing Kambo but it is advisable to make sure to let know if you have been affected with any of the following: 

Conditions of the Oesophagus:
Do you have any allergic reactions? Check all that apply

Psychological Health

To ensure your safety and well-being during your ceremony it's important that I am fully aware of any psychological health conditions you are currently experiencing or have had in the past. Please answer the following questions as honestly as possible. Rest assured, your information will remain confidential and will only be used to provide you with the best possible care.



Thank you!

Thank you so much for taking the time to complete this part of the intake. Your information is invaluable in helping me work safely with you and ensuring I can offer you the best possible support. I truly appreciate your cooperation and look forward to sharing this journey with you.

Mahalo, Nikka Alma

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