Before We Begin

Intake Form

Thank you for your interest in sacred ceremony. This form helps us understand your physical, emotional, and spiritual wellbeing so we can hold you safely. Please answer as honestly and completely as you can — everything you share is confidential and used only to keep you safe and to shape the most aligned experience possible.

Please complete this form before your ceremony. If anything feels unclear or you'd like to talk something through, reach out anytime and we'll walk through it together.

Before you submit, please read & confirm

  • I have read and understand this form.
  • I consent to share this information for the purpose of safe facilitation.
  • I acknowledge that I am participating voluntarily.
  • I am not pregnant or breastfeeding.
  • I will be fasted 8–12 hours before my Kambo session.
  • I will be intoxicant and medication free for my session.
  • I understand it is my responsibility to inform Jimmy of any medical conditions or addictions that may affect my ability to attend a session, and to keep this information updated.

You'll confirm your agreement to these at the bottom of the form below.