Intake Form | Empowered Wellness Solutions

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Kambô Intake Form

Thank you for your interest in Kambo treatments; Please follow the link below to provide your information so that your Kambô practioner can best prepare for your free consultation

contact me:

nikkiokambo@aol.com

nikki o'malley

Kambo Disclaimer

Kambo Intake Form

Kambô is safe when administered by a properly trained practitioner. However, there are instances where kambo is contraindicated. It would not be safe for you to receive kambo if you have experienced the following health conditions.........Please check any that may apply:

If you have a heart condition

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 a blood clot

If you have a serious mental health condition

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, maybe pregnant or breastfeeding

If you have eaten within 8-12 hours of treatment

If you have had any water based detox 7 days before or after your kambo session (Colonics, enema, liver flushes, water fasting)

If you have Addison's Disease or Ehlers Danlos Syndrome

If you have any of the conditions listed above it is extremely important that you disclose that to your Kambô practioner.... Truthful Information *:

I confirm that all information given is truthful and correct and that I do not have any of the contraindications listed above.

I have read, understood, and accept the Kambo Disclaimer

Thanks for submitting!

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Kambo Disclaimer

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Kambo Disclaimer

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