CUPPING THERAPY CONSENT FORM

  • Cupping is a therapy, which applies negative pressure on the skin using glass or silicone cups. The suction created stimulates and increases blood flow which can help relieve joint and muscle pain, reduce inflammation, accelerate recovery, increase the function of the lymphatic and circulatory system and increase overall relaxation and wellbeing. By creating suction, negative pressure cupping lifts and releases congested connective tissue (by aligning the collagen fibers), loosens adhesions and helps re-oxygenate old tissues that have been injured while increasing healthy circulation to the targeted area. The benefits of cupping are numerous.

     

    Please check and sign the consent agreement below:

    • I understand that the vacuum formed by cupping may result in marks being left on my
    • I understand cupping marks can be considered as bruises. These marks indicate congestion in local blood circulation and are an indication that local capillaries have been broken and metabolic waste removed.
    • I understand these marks should dissipate within a few hours to as long as two weeks.
    • I understand as cupping treatments continue, the discoloration of these marks will become less obvious.
    • I understand cupping marks should not be tender to touch and no pain should be felt.
    • I understand that ‘Physiocupping Therapy’ will not accept liability or expenses resulting from any illness, injury or untoward occurrence arising from the conduction of cupping, unless caused by negligence
    • I agree to inform my practitioner if I have the following conditions and to list any medications I am currently taking; (please tick)
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  • This field is for validation purposes and should be left unchanged.