All medicine Initial Assessment and Health Overview

May be used for human design reading.
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To ensure that you have the best possible experience during your medicine Ceremony, we would like to have some more information about your medical history, medication and any supplements. The information you provide will help us determine the appropriate dosage of the medicine and assess whether it is safe for you to undergo a psychoactive journey. It is crucial that you provide this information honestly and in its entirety. Failing to do so can significantly impact your journey, overall well-being and even your life. Please inform us if you have ever experienced or are currently dealing with a physical or mental health condition, regardless of whether or not you are taking medication for it. In most cases, it is usually safe for you to continue your normal medication, but it's important to discuss this with us beforehand. By providing us with accurate and complete information, you allow us to ensure your safety and maximize the benefits of your experience.


Kambo is a powerful medicine works deeply and needs to be respected so that we can tailor your experience to meet your needs. Rest assured that all information you provide is confidential, and any behaviours or recreational drug use will not be judged but rather taken into consideration during the treatment. We need a comprehensive overview of your health and well-being before proceeding. Please note that Kambo is entirely safe when administered by a properly trained practitioner. We are fully Certified Advanced (Morten) & Master (Annabelle) Kambo Practitioners under the IAKP (International Association of Kambo Practitioners). You can find more information about this organization at If you are menstruating at the time of treatment, please be aware that Kambo may potentially increase the flow for 24-36 hours due to its powerful vasodilators. If you have asthma, it is essential to have your inhaler with you during the session. If you have diabetes, it's important to discuss your treatment in advance. If you have been engaged in long-term water fasting, especially leading up to the treatment, it is crucial that you inform us.

Sacred Fungi

There is a psychedelic compound in mushrooms that affects serotonin receptors in the brain, leading to positive changes in perception, thoughts, and mood. There is a lot of research being carried out now that suggests that taking mushrooms can have positive effects on wellbeing. Some of the potential positive effects include: • Reduced symptoms of depression and anxiety. • Increased psychological well-being • Enhanced emotional openness and empathy • Alleviation of existential distress • Positive behaviour change

Please complete this health form as thoroughly as possible:

Kambo Specifically : Conditions of the Oesophagus

Because Kambo can cause violent vomiting we need to have some caution around certain conditions that could weaken the Oesophagus/Esophagus. These do not necessarily preclude you from experiencing Kambo but it is advisable to make sure to let know if you have been affected with any of the following: 
List all vitamins, minerals, herbs, homeopathics, and other health aids. (It is essential that you list ALL supplements) Supplement & Dosage. For What? For How Long?

Thank You!

Thank you for taking the time to complete this part of the intake. It will help us to work safely with you and to optimise the support I can offer you. Part two of the intake will focus on your formative personal experiences and life events, wellbeing, past and present psychological states, what you are looking for in working together and where you are in your life right now.


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