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Participant Information Form

If you wish to book a Kambo session please complete the form below and I will get back to you shortly.

Thank you!

1. Are you currently taking any medication and what dosage?
2. Do you have any chronic illness?
3. Do you have any current medical conditions?
4. Have you been vaccinated with covid vaccine?
5. Do you have any alergies?
6. Do you or have you in the past suffered from a psychological disorder?
7. Have you experienced seizures or been diagnosed with epilepsy?
8. Have you ever had a stroke, heart attack or any other heart related issues?
9. Are you taking any drugs?
10. Do you have a drug or alcohol addiction?
11. Have you had an operation or surgery of any kind recently?
12. Do you have any cardiovascular problems or very high/low blood preasure?
13. Is there anything about your physical/mental state I should know about?
14. Do you have previous experience working with Kambo medicine? If so, please specify the last ones.
15. Why would you like to receive Kambo now?

Kambo cannot safely be used if you have any of the following health conditions:

  • If you have a heart conditions

  • If you have had a stroke

  • If you are on medication for low blood pressure

  • If you have had a brain hemorrhage

  • If you have had an aneurysm

  • If you have had a blood clot

  • If you have a serious mental health problem

  • If you are currently undergoing chemotherapy or for 6 weeks afterwards

  • If you take immune-suppressant medication for an organ transplant

  • If you have had an organ transplant

  • If you are pregnant

  • If you are breastfeeding a child under 6 months of age

  • If you have had any water based detox within 3 days prior to your kambo treatment (for example: colonics, enemas, liver flushes)

I hereby certify that I have accurately and truthfully completed the above Participant Information Form and read the contraindications.


With submitting this form You agree to accurately represent the information provided to Katja on or through her Website. You acknowledge that you are participating the session voluntarily and that you are solely and personally responsible for your choices, actions and any results, now and in the future. You accept full responsibility for any consequences of Kambo use, or non-use. 

Cool, I'll be with you shortly :)

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