All information collected in this application is confidential. Our facilitators will review your application and may ask you follow up questions based on the results. Please answer thoroughly and truthfully.

Name *
Do you currently have, or have you been diagnosed with any of the following medical conditions?
Kambo is an Amazonian frog medicine that is typically applied via burning to the skin and causes a strong purgative effect. It can be contraindicated with some of the medicines we use on our retreats.