Participant Information Form

Kambo cannot safely be used if you have ever any of the following health conditions:

• If you have a heart conditions
• 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 aneurism
• If you have had a blood clot
• If you have a serious mental health problem
• 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
• If you are breastfeeding a child under 6 months of age
• If you have eaten within 12 hours prior to treatment
• If you have had any water based detox within 3 days prior to your kambo treatment (for example: colonics, enemas, liver flushes)

I hereby certify that I have accurately and truthfully completed the above Participant Form and read
the contraindications.