KAMBO & BUFO PARTICIPATION FORM

Name *

First

Last

Email *

Date of Birth

Phone *

What type of session are you interested in? Kambo, Bufo, or both? *

one-on-one Kambo sessions and private Bufo ceremonies. For inquires about private group sessions, please reach out. Umbanda ceremonies held periodically throughout the year.

What is your experience with Kambo or psychedelics? Is this your first time? *

Please note Kambo is considered psychoactive but is NOT psychedelic. Bufo is 5MEO DMT

Please write your intention. What are you seeking to heal or clear? *

Do you have any health diagnoses? Please write your physical/mental/emotional symptoms and history of surgeries *

Are you taking any medications, herbs, or supplements? *

Are you pregnant or breastfeeding? *

Yes
No

Terms of Service *

I agree that all of the information I have provided here is complete and accurate.

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KAMBO & BUFO PARTICIPATION FORM

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