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Kambo Soulsong: Ceremony Application
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1.
Question 1.
Date of Birth:
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2.
Question 2.
Name:
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3.
Question 3.
Email Address:
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Question 4.
Phone number:
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5.
Question 5.
Have you sat with Kambo before? If yes, how many times and please describe your experience.
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Yes
No
Comments:
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6.
Question 6.
Have you worked with other plant/animal medicines? If yes, please list them.
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Yes
No
Comments:
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7.
Question 7.
What are you hoping to gain or heal by working with Kambo?
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8.
Question 8.
What have you tried so far to heal this issue(s)?
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9.
Question 9.
Have you researched the physical effects of Kambo and are you familiar with how it affects the body/energy system?
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- Required.
Yes
No
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10.
Question 10.
Are you aware that Kambo is not psychoactive, (it is a purgative ordeal medicine) and does not produce visuals as it's cousin Bufo the Sonoran Desert Toad?
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- Required.
Yes
No
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11.
Question 11.
Are you willing to do integration work after your ceremony to ensure sustainable healing?
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- Required.
Yes
No
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12.
Question 12.
On a scale of 1 to 10, how committed are you to making a change in your energy and in your life? If not a 10, why?
1- Not committed at all
10 - I'm all in!
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10
Comments:
This is required
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13.
Question 13.
Do you have or have you had any of the following conditions: If yes, please explain.
Cardiovascular Disease
Heart Attack
High of Low Blood pressure requiring medication
Seizures
Organ Transplant
Stroke
Blood clots
Immune system disorder
Cancer/Chemotherapy
Chemotherapy implant
Parkinson's
Addison's
Donated blood plasma within 30 days
Psychological diagnosis besides Depression/Anxiety/PTSD
Pregnant or breastfeeding
Active Ulcer
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Yes
No
Comments:
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14.
Question 14.
Are you currently taking any prescribed pharmaceuticals, nutritional supplements, or over the counter medications? If yes, please list.
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Yes
No
Comments:
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15.
Question 15.
Have you received an injection for COVID-19? If yes, please list the date(s).
Yes
No
Comments:
This is required