Kambo Waiver · Primal Coherence

Section 1 — Pre-session guidelines

Please read the following carefully. Mixing Kambo with any of the following could be extremely dangerous.

Immune suppressants for autoimmune disorders.
Slimming or sleeping supplements, including melatonin. (Open to discussion if necessary.)
Alcohol or drugs within 72 hours before and after.
Do not fast longer than 18 hours in the 7 days before or after Kambo — this includes juice fasting. Maintain a normal eating pattern leading up to your session.
Sweat lodges, colonics, enemas, liver flushes, or any water-based detox within 3 days either side of Kambo.

I have read and understood the guidelines above regarding what should be avoided before Kambo.

Section 2 — Contraindications

You should not participate in a Kambo session if any of the following apply to you.

Serious heart problems.
Ehlers-Danlos syndrome.
Medication for low blood pressure.
History of stroke or brain hemorrhage.
Aneurysms or blood clots.
Inability to make a voluntary, informed decision to receive Kambo.
Severe mental health conditions. (Depression, PTSD, and anxiety are not contraindications.)
Currently undergoing chemotherapy, radiotherapy, or immunotherapy, or within 4 weeks afterward.
Taking immunosuppressants for organ transplant.
Addison's Disease.
Severe epilepsy.
Recovering from a major surgical procedure.
Under 18 years old.
Participated in a Bufo ceremony within the past 6 weeks.
Active addiction to any substance including alcohol, benzodiazepines, heroin, methamphetamine, or research chemicals.
Pregnant, potentially pregnant, or breastfeeding a child under 6 months old.
Currently taking a daily diuretic. If your medication is also a diuretic but not required daily, please discuss with your practitioner before booking.
Consumed other strong plant medicines (e.g. ayahuasca, San Pedro, psilocybin) within 24 hours.
Consumed large amounts of water prior to arriving for your session.
Fasting longer than 18 hours.

I have read the contraindications above and confirm that none of them apply to me. I understand the risks involved should I choose to disregard this information.

Section 3 — Substance interaction guidelines

Please review the required abstinence periods before and after your session.

Substance	Before Kambo	After Kambo
Alcohol (high doses)	48 hours	7 days
Alcohol (low doses)	12 hours	24 hours
Amphetamines (Adderall, Ritalin)	7 days	7 days
Antidepressants / anxiety medication	Do not take morning of	8 hours
Anti-convulsants	Must discuss with facilitator
Anti-epileptics	CONTRAINDICATED
Anti-psychotics	CONTRAINDICATED
Ayahuasca & analogues	At facilitator's discretion
Benzodiazepines (Valium, Diazepam)	18 hours	8 hours
Beta blockers	Do not take morning of	8 hours
Blood thinners	Do not take morning of	8 hours
Botox	7 days	7 days
Bufo / 5-MeO-DMT	6–8 weeks	None
Cannabis	12 hours	24 hours
Cocaine	3 days	5 days
Codeine	24 hours	24 hours
Crack cocaine	7 days	7 days
Ecstasy (MDMA)	7 days	7 days
Fentanyl	CONTRAINDICATED
GHB	7 days	7 days
Heroin (recreational)	14 days	14 days
Heroin substitutes (Methadone, Buprenorphine, Naltrexone)	CONTRAINDICATED
High blood pressure medication	Do not take morning of	8 hours
Iboga	90 days	4 hours
Ibogaine	10 days	4 hours
Ketamine	3 days	3 days
LSD	48 hours	72 hours
Methamphetamine	30 days	30 days
Morphine / Oxycodone	5 days	5 days
N,N-DMT	8 hours	8 hours
Peyote / San Pedro (mescaline)	At facilitator's discretion
Psilocybin	At facilitator's discretion
Tramadol	48 hours	24 hours
Vasoconstrictors (Triptans)	3 days	12 hours

I have reviewed the substance guidelines above and confirm that I understand and will comply with the required abstinence periods before and after my Kambo session.

Section 4 — Release of Liability

Primal Coherence — Jane Savina — Kambo Session Release of Liability and Assumption of Risk

Kambo is the bioactive peptide secretion of the Phyllomedusa bicolor frog. Your practitioner, Jane Savina of Primal Coherence, is not licensed in the medical field and does not diagnose, prescribe, treat, or cure any medical conditions. Kambo treatment is not a substitute for medical care. Please consult a qualified physician for any illness or disease.

Agreement to Follow Directions. I agree to follow any oral instructions or directions given by Jane Savina / Primal Coherence.
Assumption of Risk & Release. IN THE EVENT OF ACUTE ADVERSE EFFECTS RELATED TO KAMBO, CALL 911. I recognize that there are inherent risks associated with this activity and I assume full responsibility for personal injury to myself. I further release and discharge Primal Coherence and Jane Savina for injury, loss, or damage arising out of my participation in any services provided. Known possible side effects may include: increased heart rate, flushing of the skin, pressure in the head, numbness or tingling, flu-like symptoms including nausea, chills and abdominal cramping, vomiting, and tetany.
No Duress. I agree and acknowledge that I am under no pressure or duress to sign this agreement and have been given a reasonable opportunity to review it.
Indemnification. I, for myself and on behalf of my heirs, assignees, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Primal Coherence and Jane Savina, their agents and/or employees, with respect to any and all injury, disability, death, or loss or damage to person or property, WHETHER ARISING FROM NEGLIGENCE OR OTHERWISE, to the full extent permitted by law.
Enforceability. If any provision of this agreement is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.
Dispute Resolution. The parties will attempt to resolve any dispute through good-faith negotiation, and if not resolved, through binding arbitration.

I have read and fully understand the Release of Liability and Assumption of Risk Agreement above and voluntarily agree to its terms.

Your information

Full name *

Date of birth *

Phone number *

Emergency contact name & phone number *

Current medications (name and dosage) *

Anything else about your health history your practitioner should know *

Electronic signature

By typing your full name below, you are signing this document electronically. You confirm that you have read all sections of this waiver, that none of the contraindications apply to you, and that you are voluntarily consenting to receive Kambo at Primal Coherence. Your typed name constitutes your legal electronic signature.

Type your full name to sign *

Date signed *

By checking here, I consent to the use of my electronic signature in lieu of an original signature on paper. I confirm that all information provided in this form is accurate and complete to the best of my knowledge.

Your submission is sent securely to your practitioner.
You will receive a confirmation once it has been reviewed.

Waiver received 🌿

Thank you for completing your Kambo waiver. Jane will review it before your session.
Questions? Text (443) 254-6762.