Cupping Therapy Client Release Form

    • 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.
    • Information has been provided to me about Cupping Therapy.  If I choose to experience these therapies during treatments, I understand the potential effects and after-care recommendations.  
    • It has been explained to me that there are contraindications for Cupping Therapy.  I have fully disclosed all health factors to my therapist, including those not mentioned on my Health History Intake Form, to avoid any complications.
    • 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 and toxins being drawn to the surface to be cleared away by my circulatory systems.
    • 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’s immune system can temporarily react to this release as it might with the flu – producing flu-like effects like nausea, headache, aches, that will subside in time with rest and water.  Water helps to dilute the intensity of the release.
    • I understand that Cupping Therapy modalities should not be combined with aggressive exfoliation, 4 hrs after shaving, after sunburn or when I’m hungry or thirsty.
    • I understand that I should avoid exposure to cold, wet, and/or windy weather conditions, hot showers, baths, saunas, hot tubs and aggressive exercise for 4 - 6 hours.  I understand that exposure to such extremes can produce undesirable effects and I should avoid such situations.
    • I understand that I should avoid caffeine, alcohol, sugary foods and drinks, dairy and processed meats and I should consume an abundance of clean water.