Kambo Contact FormPlease complete the form below Name * First Name Last Name Email * Phone * (###) ### #### Address (City, State) * Subject * Medications * Are you now or recently been on any Psychotropic meds and substances including but not limited to SSRI, SNRI, NDRI, or MAOI meds e.g. for depression, anxiety, ADHD and such? If yes, please explain in the Message filed further below. Yes No Do you have any heart issues including high-blood pressure? * Any major health issues? If so, please explain * Past Experience * Do you have any experience with Kambo and/or plant medicine and if so which and when was your last experience? I am interested in: * Full Traditional Kambo Session Microdosing Kambo Session Settings Group Ceremony (up to 4 participants, applied individually, held monthly) Private Ceremony What would be your primary goal in doing Kambo? * Date of Birth * MM DD YYYY Where did you originally hear about us? * Message * Would you like to receive our monthly events newsletter? * You can unsubscribe anytime. Yes No Thank you! Your form had been submitted. It will be reviewed and you can expect a response, typically within 1-2 business days.
