We are excited that you have decided to take part in a kambo treatment. Taking part in the treatment is entirely voluntary. We urge you to discuss with us any questions about the processes you might encounter during the treatment. We ask that you read all the information we have sent to you to ensure you qualify for a kambo treatment. It is necessary your read this carefully to understand the discomforts and risks, and agree to take part. Some of the essential information you will need to know to participate in the treatment has been outlined below. CONTRAINDICATIONS: Please read through these contraindications and let us know if you have any of these conditions which would make it not safe for you to take kambo. • People with serious heart problems • People who have had a stroke. • People on medication for low blood pressure (this is extremely rare). • People who’ve had a brain hemorrhage. • People who have aneurysms or blood clots. • People who lack the mental capacity to make the decision to take Kambo. • People with severe mental health problems, excluding depression and anxiety. • People undergoing chemotherapy or radiotherapy for 4 - 6 weeks afterward. • People who take immune suppressants for organ transplants. • Women who are pregnant or maybe so. • Women who are breast-feeding a child under 6 months old • People with Addison’s disease • People with Ehlers-Danlos Syndrome • People with severe Epilepsy currently • Are recovering from a major surgical procedure • Under 18 years of age CAUTIONS BEFORE AND AFTER TAKING KAMBO Caution is also required in the following cases. • People taking immune suppressants for autoimmune disorders. • People taking slimming, serotonin, or sleeping supplements. • Active drug or alcohol addiction. • Long-term or water fasting for 7 days before or after Kambo other than required fasting. • Colonics, Enemas, liver flushes, or any water-based detox should be avoided within 3 days on either side of taking Kambo. Please let us know if you have concerns about any of the above. DISCOMFORTS AND RISK: Though kambo is safe for most people, the following discomforts and risks could be associated with your kambo treatment. Some discomfort may follow for 1-5 days after taking kambo. Most are resolved by the next day; however, some may persist longer. Some discomforts may include nausea, vomiting, headache (due to toxin release or tension), feeling fatigued and sleepiness, and possible depression. Please note that this can be a process and usually resolves within 1-5 days. There are some risks that if you have an existing condition, you may experience a Herxheimer effect, which is when the symptoms get worse before getting better. Much like when you are detoxing. To date, there have been four instances of esophageal rupture after using kambo. Kambo is not the cause of these ruptures; however, if there is a pre-existing condition, a rupture could occur. Though this is very rare, it is important that you understand all possibilities. If after kambo you experience dizziness, pain, or vomiting blood, please call your practitioner and seek medical attention. CONSENT TO PARTICIPATE IN KAMBO TREATMENT Before making the decision regarding participation in this Kambo treatment, you should have • Reviewed the information in this form. • Had the opportunity to ask any questions you may have. • Done individual research on Kambo. Checking the box and entering your full name below means that you have received this information, have asked the questions you currently have about the treatment and those questions have been answered. PARTICIPANT