KAMBO & BUFO PARTICIPATION FORM

Help us tailor our approach to best suit your needs.

Help us tailor your needs with in-depth details.

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.

KAMBO CONTRAINDICATIONS

We cannot administer Kambo safely if you have any of the following

Heart condition
History of stroke
Medication for low blood pressure
History of brain hemorrhage or aneurism
History of blood clots
Serious mental health problems
Undergoing chemotherapy or immune-suppressant medication
Pregnancy or breastfeeding a child under 6 months
Fasting for 7 days prior to Kambo treatment
Water-based detox within 3 days before Kambo treatment (e.g., colonics, enemas)
Taking immune therapy drugs
Recent stem cell therapy
Currently undergoing chemotherapy
Addison’s disease
Taking Benzodiazepines
3rd or 4th stage of alcoholism
Esophagus ruptures
Ulcers in the stomach
Lyme disease flare-up
Staph

BUFO CONTRAINDICATIONS

Bufo cannot be administered under the following conditions

SSRI’s
SSNRI’s
Opioids
Heart Murmur
History of stroke
Pre-existing cardio-vascular disease
History of blood clots
Psychological conditions
Schizophrenia
Psychosis
Manic-depression
Bi-polar disorder
Serious Asthma
Respiratory disorders
PTSD
OCD…etc

Although some conditions such as PTSD and depression may be benefited by participation, these considerations must be made very carefully and on a case-by-case basis.

All information provided is confidential

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KAMBO & BUFO PARTICIPATION FORM

Help us tailor your needs with in-depth details.

KAMBO CONTRAINDICATIONS

EMBARK ON A JOURNEY OF SELF-DISCOVERY!

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