Name
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First Name
Last Name
What is your city and state?
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What type of offering/experience/session are you interested in?
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Ceremony Preference
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Please click all that apply... You may select more than one.
If you would like to experience this work with a friend or loved one, what is their name?
Have you ever experienced lab drugs like LSD or MDMA?
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What are some areas of your life that you feel blocked in or would like to improve?
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For example, career, wellness, motivation, clarity etc. Please explain.
Are you currently taking any herbs, medications or supplements?
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Please list any and all medications, supplements and herbs that you take, even if you don't think there could be a contradiction. Thank you.
Is any of this applicable to you?
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If so, please be 100% transparent and click all that applies to you.
re: Covid
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Please be 100% transparent and select all that applies to you.
Re: Covid Vaccine
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Please be 100% transparent and select all that applies to you.
Re: Covid Vaccine side-effects, if any?
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If you got the COVID vaccine and you experienced any type of side effect, or if it is ongoing, please make a note of that here. If you did not get the vaccine, please note that instead. Thank you.
Re: Recent Vaccinations
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Please list any other Vaccinations (excluding Covid) taken within the past 3 years.
For example, Flu shot Winter 2023 etc
Have you ever experienced depression or anxiety? Does anyone in your family?
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If so, please be specific below.
Are you pregnant or breastfeeding?
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What is your diet like?
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Please be specific. What do you eat?
How many glasses of water do you drink per day?
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Have you done any type of food, juice, water etc. cleanse recently? Had an enema or a colonic? Please explain and when.
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ADDITIONAL Blood Pressure questions
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In order for your application to be considered valid, prior to doing work with us, you must be willing to test your blood pressure. Most drug stores have monitors for sale or for use.
What do you do for a living?
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Do you like it?
Do you work online/remotely? Or in person with others?
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Date of Birth?
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Email Address
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Please confirm e-mail address
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Can we text the phone number provided to reply to your application?
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Anything else to add or ask? Let Kambo Care know! We appreciate your transparency!
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By filling out this application you accept liability for yourself. Can you accept personal responsibility?
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Are the answers you provided honest?
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