Waiver Form

Please be aware that if I am needed to travel a good distance for the session, I might ask to cover the travel cost.

Please be completely honest with your practitioner at Anima Pacha Drums. By making a full disclosure of any medications or serious medical conditions (not listed below) may protect both yourself and the practitioner. Please take the time to share and to let the practitioner know of your special needs prior to your treatment.

Exceptions and Contraindications:

Kambo has no known detrimental side effects, when it is responsibly administered it is completely safe. There are very few people who cannot take it, but this is not an exhaustive list so please let me know beforehand if you have serious health problems.

PLEASE MAKE SURE THE FOLLOWING BOXES ARE FILLED IN

Please specify which treatment are you booking for:

1 Are you under 18?

2 Heart problems (heart attack, pacemaker…)

3 Do you suffer or suffered from Blood cloths?

4 Low / High blood pressure that is controlled by medication?

5 Do you suffer or suffered from fainting or dizziness?

6 Are you pregnant?

Add your text

7 Are you breastfeeding a child under 1 year old?

8 Do you suffer or suffered from Psychosis or Bipolar Disorder?

9 Are you suicidal or have serious Mental Health conditions?

10 Do you suffer or suffered from Addison’s Disease?

11 Did you had any organ transplant surgery?

12 Do you have issues with your Pancreas?

13 Are you on any Immune suppressants?

14 Are you on steroids?

15 Do you suffer or suffered from Oesophageal condition?

16 Do you suffer or suffered from Epilepsy?

17 Do you suffer or suffered from Stroke?

If you answered ‘YES‘ to any of the above, please give as much information in the COMMENTS section below.

1. I fully understand that Ilona Dovey at Anima Pacha Drums is not a licensed medical doctor, does not diagnose or treat disease, and that I am not here for medical or diagnostic procedures.

2. Suggestions and treatments offered for my well-being are not intended to take the place of qualified professional medical care, including the diagnosed treatment of named diseases.

3. I understand that assessment and suggestions regarding diet, nutritional supplementation, Shamanic healing, natural herbal detox and herb/compounds or preparations, remedies, essential oils offered here or elsewhere are based upon the observations through Shamanic training and are not intended to replace standard medical treatment or advice from licensed health care professionals.

4. I agree that all nutritional supplements, herbs, extracts, remedies, etc., are taken at my own risk. As with any ingested substance, an allergic reaction is a possibility in some individuals. I have been informed of the risks and consequences involved. I agree that I and my heirs, guardians, legal representatives and assigns will not make a claim or file any action against myself or any members of Anima Pacha Drums for injury or damage resulting from negligence or other acts, whatsoever, caused in connection with my consultation.

5. I also understand that Anima Pacha Drums will not be held responsible for errors/ ingredients on the part of any manufacturer or supplier of products offered here or elsewhere.

6. I hereby consent to authorise Anima Pacha Drums to practice Shamanic and Energy healing, Kambo Natural Detox and associated therapies such as Feather Stone energy healing or other alternative modalities that may be implemented upon reasonable assessment. I understand that these modalities may cause minor bruising, swelling, dizziness, tiredness, migraines, shallow bleeding or other mild effects. (These are normal reactions and not a cause for any concern.)

7. I understand that if I do not disclose certain medical conditions or health concerns to Anima Pacha Drums, it will be my responsibility, and I will take no legal action against Anima Pacha Drums.

8. Any information shared in sessions is confidential and will not be disclosed to any party, be they family or medical provider. However, for educational purposes, it may be shared anonymously with mentors and co-students.

9. Occasionally, Anima Pacha Drums may ask if you would allow them to take your photograph during any of the personal sessions offered, which then can be shared on the website or social media.

I have carefully read this agreement and fully understand the content. I am aware that this is a waiver and release of potential liability and a contract between Anima Pacha Drums and myself and sign it of my own free will.

I affirm that I have completed the health questionnaire honestly, provided all necessary information, and agree to all terms and conditions. By signing this form, I acknowledge that I have thoroughly read and understood this agreement. I recognise that it constitutes a waiver and release of potential liability, forming a binding contract between Anima Pacha Drums and me, which I enter into voluntarily.

Ilona Dovey

Anima Pacha Drums

07535749686

animapachadrums@gmail.com

www.animapachadrums.co.uk