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Medicines of Love

Toronto, Ontario

© 2023 Medicines of Love

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Thanks for your message, we'll be in touch shortly.

Hello and that you for reaching out. We are no longer accepting new clients. Exciting new shifts will be coming to Medicines of Love. We have been happy to serve the community but the time has come take a pause. If you would like to be kept up to date with any new offerings, if we will be opening out client list again or for a referral to a trusted practitioner, please email: medicinesoflove@gmail.com.

Please note, contact form is no longer active

First Name

Last Name

Phone number

Email

Emergency Contact

Emergency Contacts Phone Number

What offering are you interested in?

If Unsure/Other, please elaborate

Please take a moment to explain your intention/reason for wanting to participate in the offering? The more detail provided, the better we can support you.

On a scale of 0-5, with 0 being the lowest and 5 being the highest, please indicate your level of: Stress

On a scale of 0-5, with 0 being the lowest and 5 being the highest, please indicate your level of: Anxiety

On a scale of 0-5, with 0 being the lowest and 5 being the highest, please indicate your level of: Support from family/friends/community

Have you had any issues with your heart, including any high or low blood pressure? *

If yes, please explain in detail.

Have you experienced any seizures, or do you have a seizure condition such as epilepsy?

If yes, please explain in detail.

Do you have been diagnosed with, have past history of, or currently living with any of the following:

Cardiovascular Disease, Including Heart Attacks High or Low Blood Pressure Mental Illness (Anxiety, Depression, Bipolar, Schizophrenia, etc.) Recent Surgery Past or Recent Physical Injuries (Fractures, Dislocations, or Muscle Injury) Glaucoma, Retinal Detachment or any Eye Disorders Recent or Current Infectious Diseases or Communicable Illnesses Seizures or Epilepsy Asthma or Other Respiratory Conditions Diabetes Cancer Digestive Issues Chronic Illness Addiction Organ or Tissues Transplant

If yes, please explain in detail.

For participants assigned Female at birth:

Are you pregnant or do you suspect you might be pregnant? Are you breastfeeding? Might you be on your moon cycle at the time of ceremony?

Please provide any additional details you may feel are of relevance.

Please list any recreational or ceremonial substances you may have consumed in the last 2 months (including alcohol, tobacco, marijuana, LSD, psilocybin, etc.). Include the frequency of use.

Please list any pharmaceutical medications you are currently on. Include dosage and frequency of use. It is important that you share the frequency of use and the dosage.

Please list any supplements you are currently on.

Do you have any allergies?

If yes, please provide details (please include environmental, scent and pet allergies).

Do you go to therapy or are you in a support group? Please provide any pertinent details. *

Do you have any health or medical conditions that have not been shared above?

People with extensive trauma histories or who have experienced significant trauma need special considerations when working with these medicines. Is it possible that you fall into this category? (Please note, even if the traumatic event/s happened long ago and/or are not seemingly affecting you today, it is important to discuss this durning your phone consultation)

Have you received an mRNA vaccine in the last 6 weeks? If yes, please provide the following information below: i) Date of Vaccine 1 ii) List any side effects experienced

Do you have any fears or phobias?

If you have experience working with Kambo and/or Bufo then please provide the approximate month/year of your last ceremony and name of your practitioner(s)

Please list past experience with plant/spirit ceremonies, who the facilitator was and where the ceremony took place. (Please include any other ceremony experience such as, Cacao ceremony, Sweat Lodge/Temazcal, Moon Circles etc) *

Consent and Liability Waiver
I acknowledge that participation in the sacred ceremony may involve discomfort and unexpected physical, mental or emotional upset. In submitting this release document, I agree to waive all rights to seek or receive compensation in case of injury, loss or damage. I choose to attend this work as a result of my research and interest in ceremonies. I understand that my participation in this ceremony is entirely voluntary and I agree to remain at the ceremony to its completion. I accept that the ceremony practitioners and helpers make no claim or promise about the curing of illness of any kind, or about the nature of any spiritual experience which I understand is entirely personal. I understand that my participation in the ceremony may be physically, mentally, emotionally or spiritually demanding. I understand that I may experience dizziness, nausea or other physical upset including vomiting and diarrhea. I accept full responsibility for anything that may occur including emotional disturbance, mental disorientation and any and all possible manifestations of physical, emotional and mental changes. I acknowledge that I am aware of the risks and potential benefits of my participation and I freely choose to enter this process, accepting full responsibility for whatever may occur whether anticipated or unanticipated. I acknowledge that I will make alternate arrangements for transportation in the event that I may be physically or mentally exhausted and/or disoriented after the ceremony. I am informed of the nature of the ceremony, the needed preparation and the rules of the ceremonies. I commit myself to stay in the circle until the end of the ceremony and to respect the directives given by the organizers, helpers and facilitators(s) of the ceremony. I hereby knowingly and voluntarily assume the full risks of any physical or moral injury, damage or losses, either to myself or caused to others by me during the Ceremony. I hereby waive the liability of and agree to hold harmless: the practitioner(s), all the helpers, associates, employees, agents, staff, family successors, volunteers and other participants. I further agree to defend and indemnify them from any claims, suits and demands. This agreement is binding upon myself, my spouse, parents, family, heirs, executors, administrators, agents and assigns.

I hereby confirm that I have read and understood the above information and have answered all the questions completely and honestly and have not withheld any information. I have read, understood and consent to the waiver voluntarily.

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About
Kambo
Bufo
SPMI Therapy
Packages
FAQ

About
Kambo
Bufo
SPMI Therapy
Packages
FAQ