Kambo & The Rose Inquiry

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Please complete this form to provide the details needed to personalize your session. Once submitted, I will carefully review your responses and email you soon with details about scheduling your session. If you have any questions, you can contact me at aloha@naomilove.org. Thank you for taking this step in your journey—I’m looking forward to working with you!

Email *

Name *

Phone Number *

Location *

Do you have any current or past medical conditions? (Please list and provide a brief description)
*

Are you currently taking any medications, including herbal supplements or over-the-counter remedies? (Please list)

Have you ever experienced any of the following? (Check all that apply)

Heart conditions

High Blood Pressure

Low Blood Pressure

Stroke

Diabetes

Autoimmune disorder

Depression

Anxiety

Epilepsy or other neurological disorders

Chronic pain or inflammation

Required

Do you have a history of substance use or are you currently in recovery? If yes, please share your experiences
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Have you participated in Kambo ceremonies before? If yes, please share your experiences
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Have you worked with other plant medicines or healing traditions? If yes, please share your experiences
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Do you have any experience with other spiritual or shamanic practices? If yes, please share your experiences
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What is your primary intention for seeking Kambo?
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Are there any specific physical, emotional, or spiritual issues you wish to address?
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How did you hear about my Kambo ceremonies?
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Which ceremonial option resonates with you?
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Swift Cleanse (3-hour ceremony)

Excavate, Purify & Integrate (Day-long immersion)

Metamorphous Alchemize (3-month immersion)

Is there anything else you would like me to know about you or your intentions for the ceremony?
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Do you have any questions or concerns about the process?
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Acknowledgment and Agreement: I understand that Kambo is a powerful medicine and involves a purging process. I acknowledge that I have provided accurate and truthful information in this form.
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I Understand

A copy of your responses will be emailed to the address you provided.

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