The rituals of Medaram are unique among Indian temple traditions — there are no permanent idols here. The Goddesses Sammakka and Saralamma are worshipped in the form of vermilion (kumkuma) kept in sacred containers, carried from the forest by tribal priests and installed on raised platforms known as Gaddes. This tribal form of worship, passed down through generations of the Koya community, has no Vedic rituals, no temple bells, and no Brahmin priesthood — only faith carried through oral tradition.

A holy dip in Jampanna Vagu, the stream named after Sammakka's son who sacrificed his life in battle, is considered an essential ritual before proceeding to darshan. Devotees believe that bathing in these waters cleanses them of sins and ailments, and the stream holds deep symbolic meaning as a tribute to Jampanna's valour and sacrifice.

At the conclusion of the Jathara, the ritual of "Vanapravesam" is performed, where the sacred symbols of the Goddesses are ceremonially carried back into the forest by the priests, marking their return to their divine abode. No idols remain at Medaram after this ritual — the site returns to its natural, forested state until the next Jathara, two years later.