Kambo Interest Form

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Kambo Interest Form

Thanks for your interest in doing Kambo with Soul Soil Alchemist. Please take some time to fill out this screening service so that we can make sure that Kambo is safe for you.

Once you've filled out this form, we will send you a Calendly Link to set up a short screening call.

Email *

First Name *

Last Name *

Birthday *

YYYY

Gender Identity *

Female

Male

Transgender Female

Transgender Male

Other:

What dates are you interested in sitting? *

October 23-25

December 18-20

January 8-10

Private Sit

Have you ever worked with Kambo before? *

Yes

Emergency Contact Information (Full Name, Phone Number and e-mail) *

Please let us know if you...

Have ever had a stroke

Have a heart condition

Have epilepsy

Have had or will receive chemotherapy within 6 weeks of your sit

Have had an organ transplant

Are pregnant or breastfeeding

Are taking any medications

What medications are you taking? *

None

Other:

Why are you looking to work with Kambo? *

Send me a copy of my responses.

Submit

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