Certified Kambo Practitioner Training Application

Please complete the form below if interested in applying. Allow for 15-30 minutes to complete and to avoid any loss of writing, please write lengthy responses in a word document and copy and paste. Thank you!

My Contact Information

Gender *

Female

Male

Non-binary

Other

Where do you currently live? *

How did you hear about the Kambo Practitioner Training Course? *

Who might we thank for referring you to us? *

Course Application Questions

What Location and Date are you interested in?

When did you hear a calling to work with Kambo? *

How was this call heard? *

What is your personal experience with using Kambo? *

How many ceremonies have you experienced and when?

What have you healed with the help of Kambo? *

Have you independently researched Kambo, it’s history, and how it interacts with the body/energy system?

Do you have any personal experience working with any other plant/animal based medicines? *

Medical Questions

Sapo or Kambo has no known detrimental side effects so when it is responsibly administered it is very safe. There are very few people for whom Sapo medicine may provide a health risk so please let us know beforehand if you have serious health problems. Sapo cannot be administered to those who are, (have) had or suffer from:

Are you pregnant or think that might be pregnant? *

Yes

Breastfeeding a child under 1 year? *

Yes

Do you have any serious heart conditions including pacemaker, valve disease, bypass surgery and enlarged heart? *

Yes

Please elaborate your heart conditions

Do you suffer from high or low blood pressure? *

Yes

Please describe your blood pressure conditions and any medications you take.

Have you had a stroke, aneurysm or bleeding in the brain? *

Yes

If YES, please explain your experience and current diagnosis

Have you ever had organ transplant surgery? *

Yes

If Yes, please detail the surgery and which organs.

Will you be at the end of a fast or fasting during your course? *

Yes

Please let us know of any possible contraindications below: *

Any type of infection or disease? Describe which one below.

Any prescribed medication? Describe them below.

Cardiovascular conditions? Please explain.

Pacemaker or defibrillator? Please explain.

High blood pressure?

Low blood pressure?

None

Please elaborate on any of the above checked contraindications.

Any condition already treated by GP or another complementary or alternative practitioner? *

Please elaborate on any of the above checked conditions or treatments.

Have you been hospitalized in the last 20 years? *

Yes

If you have been hospitalized, please explain.

Are you currently or have you ever received Therapy, attended a support Group, and/or worked with a Counselor, Psychiatrist, Psychologist or Psychotherapist? *

Yes

If YES, please explain including type, duration and quality of your experience.

If YES, did you receive a Psychiatric diagnosis? Please explain.

Is there anyone in your family with a history of psychiatric disorders? *

Yes

If YES, please explain your family's history.

Have you experienced traumas in your life? This includes traumatic events as well as ongoing traumatic experiences. *

Yes

If YES, has this influenced your desire to come to become a Kambo practitioner?

Do you drink alcohol? *

Yes

If YES, are you willing to fully detox off of any alcoholic substances a minimum of 7 days prior to your course??

Yes

Do you smoke? *

Yes

If YES, are you willing to either cease smoking or smoke all natural cigarettes while on the diet?

Yes

Do you use any "illegal" substances? *

Yes

If YES, are you willing to fully detox off of any substances a minimum of 7 days prior to your course? *

Yes

It's an addiction, and may be a challenge

Are you taking ANY western medical prescriptions, over-the-counter, or alternative, homeopathic medications or taking herbal supplements ? If so, please list below and explain..... *

Have you had ANY COVID vaccine? *

Yes

If, YES please list ALL vaccines and dates administered?

Is there anything else we should know about your physical or mental state? *