Your Experience
Your history with medicine and substances.
Do you have any experience with plant medicine? (If so please share which ones and how often you take them.)*
Do you take any recreational substances including drugs and/or alcohol? If so please share which ones and how often.*
Do you have a history of substance abuse? If so please explain.*
Medications & Supplements
Everything you take, however small — some combinations are not safe with the medicines.
Are you taking any other drugs like caffeine, pain killers or allergy medications?*
Are you on any prescription medications? If so which ones and what dosage are you taking / how often?*
Are you taking any of the following supplements: Kratom, mood stabilizing supplements, natural sleep aids, diet pills? Please explain and list all supplements you are taking under this category.*
Mental & Emotional Health
Shared in confidence. Nothing here disqualifies you on its own.
Do you have any history with mental illness? If so please describe.*
Do you have a history of PTSD or suffer from acute trauma? If so please explain.*
Do you struggle with addictions, depression or anxiety? Please explain.*
Do you have any of the following: schizophrenia, schizophrenic tendencies, borderline personality disorder, serotonin syndrome, bipolar disorder or suicidal tendencies?*
Please share any major traumas that have happened in your life (including childhood traumas) and any therapies or treatments you have accessed.*
Heart & Circulation
These questions matter most for your safety in ceremony.
Do you have any of the following: High blood pressure, low blood pressure, cardiovascular issues, liver & kidney, head injuries, history of seizures, respiratory issues or drug allergies?*
Do you have a history of hypertension (higher blood pressure)? Do you know your most recent vital signs including blood pressure, heart rate, oxygen saturation? (If not we will assess during your first session).*
Do you have serious heart problems? Have you had heart surgery? This includes a pacemaker but excludes stents.*
Have you had a stroke or a brain haemorrhage?*
Have you had an aneurism or blood clot?*
Are you on medication for low blood pressure?*
Medical History
Conditions and treatments we need to know about.
Are you recovering from a major surgical procedure with internal stitches?*
Are you recovering from a major surgical procedure?*
Are you undergoing chemotherapy, radiotherapy or have done so within the last 4 weeks?*
Are you taking immune-suppressants after an organ transplant?*
Do you have Addison’s Disease?*
Do you have current and severe epilepsy? Are you on any medication for epilepsy?*
Do you have certain types of eating disorders?*
Do you have Crohn’s Disease, IBS or any digestive issues?*
Do you have any pre-existing medical conditions? If so please explain.*
Have you been vaccinated with CV19 vaccine? If so, how many times and when?*
Are you pregnant or breast feeding? Are you breast feeding a child under 6 months old?*
Preparing for Ceremony
How you care for your body around the work.
Will you have been fasting at any point 7 days before or after your ceremony work?*
Will you be able to not have any enemas, colonics, intensive sweating or liver flushes within 3 days before and after your ceremony work? You will be needing all of your electrolytes and it can be dangerous if you deplete them with these methods of detox.*
Will you be menstruating at the time of your session? It can be uncomfortable to have Kambo during this time as the medicine can increase bleeding, cramping & lightheadedness.*
Can you abstain from alcohol, marijuana and other recreational substances for at least 24–48 hours before your Kambo session?*
Do you have any dietary restrictions?*
Your Intention
The part we most look forward to reading.
Please share about what is calling you to ceremony at this time.*
What resources do you have in your life to support you? Example: meditation practice, therapist, life coach, etc.*
Is there anything else that you wish to share? Do you have any further questions?*
Tiger Soul
Medicine Retreats
