Please read, sign and date this form before your upcoming cupping treatment.
*I understand that all treatments at this facility are therapeutic in nature. I agree to communicate to the therapist any physical discomfort or draping issues during the session.
*If I choose to experience these therapies during treatments, I understand the potential effects and after-care recommendations.
*I understand that there are contraindications for cupping therapy. I have fully disclosed all health factors to my therapist, including those not mentioned in my health history intake form, to avoid any complications.
*I am not taking blood thinners, experiencing a fever, systemic cancer or undergoing cancer treatment, liver or kidney functional illness, have hemophilia or bleeding/clotting disorders.
*It has been explained to me that there is the possibility of discolorations that can occur from the release and clearing of stagnation and toxins from my body. I also understand that this reaction is not bruising, but due to cellular debris, pathogenic factors, old stagnation, and toxins being drawn to the surface to be cleared away by my circulatory system.
*I further understand that the discolorations will dissipate from a few hours to as long as 2 weeks in some cases and in relation to my after-care activities.
*I understand that the first time I experience cupping, my body can temporarily react to this release with effects like nausea, headache, and aches that will will subside in time with rest and water.
*I understand that cupping therapy modalities should not be combined with aggressive exfoliation, 4 hours after shaving, after sunburn, or when I'm hungry or thirsty.
*I understand that I should avoid excessive exposure to extreme cold, wet, and/or windy weather conditions, very hot showers or baths, saunas, hot tubs, pools, and aggressive exercise for 24 hours. It has been explained to me that exposure to such extremes can produce undesirable effects and I should avoid and/or limit such situations.
*I understand that I should avoid caffeine, alcohol, sugary foods and drinks, dairy and processed foods, and I should consume an abundance of clean water.
