Name *

First Name

Last Name

ITS ESSENTIAL THAT YOU ADHERE TO THE FOLLOWING

• Refrain from alcohol use for at least a minimum of 48 hours prior to the Kambo treatment • Refrain from recreational drug use for at least a minimum of 48 hours prior to Kambo treatment and after. • Consume no food a minimum of 8 hours before Kambo treatment. • Consume only a few sips of still water on the day of the Kambo treatment, absolute maximum of 500ml. • Refrain from Water fasting & fasting 48 hours prior. A good meal is recommended the day before Kambo. • Refrain from using distilled water, enemas, colonics, saunas or sweat lodges 48 hours prior to Kambo treatment. • Refrain from receiving Kambo whilst taking antibiotics. Kambo can be taken after the course of antibiotics has been finished. • Where Benzodiazepines are used regularly or dependently, the individual must be fully withdrawn from the medication under the guidance of a health professional for a minimum of 4 weeks prior to the treatment. • All Opioid dependency or Opiates taken daily will need to be stopped entirely for a min of 2 weeks prior to treatment (codeine, tramadol, morphine, oxycontin, fentanyl, buprenorphine, methadone, heroin).

I AGREE TO THE ABOVE

DISCLAIMER *

I acknowledge that KPA practitioners are not medical doctors or any other form of medical practitioner. I understand that KPA practitioners do not diagnose diseases, offer health advice, treat physical or mental health issues, or prescribe medicine or pharmaceuticals. I accept that any complementary therapy treatment I receive is not a substitute for medical or psychological diagnosis or treatment by a qualified medical practitioner. I understand that it is recommended I consult a qualified medical practitioner for any physical or psychological problem I have now or in the future. I confirm that all the details I have provided are true and accurate. I understand that everyone’s Kambo experience is different. While Kambo has created outstanding results for others, I acknowledge that the KPA and KPA Kambo practitioner cannot guarantee any specific results. I am aware that Kambo fertility success rates vary from person to person and that it may not work for me. I hereby release the KPA and the KPA Kambo practitioner from all liability resulting from the use of equipment, materials, preparations, remedies, or treatments. I assume full responsibility for all risks associated with this treatment.

I AGREE

DISCLAIMER *

We reserve the right to refuse our services to anyone without explanation. If a client has any contraindication, we reserve the right to not work with them. If a session/course is canceled less than 48 hours before the session, no refund will be given. Unless under extreme circumstances, no refunds will be given at all, only a credit note under exceptional circumstances. We expect all clients to agree to our disclaimer before we work with them. Kambo Rebirth and the KPA are not accountable for any results or effects you may or may not experience through Kambo and our Kambo sessions. Any cancellations made more than 48 hours before the session will receive a 50% refund or a credit note for the value of the treatment.

I AGREE