PLEASE READ BEFORE SIGNING
Cupping is a form of bodywork that involves light touch and manipulation of soft muscle tissue. Cupping will never be done directly on veins, arteries, nerves, skin inflammation, any skin lesion, body orifices, eyes, lymph nodes, or varicose veins. Oil being used is an organic Safflower Oil and does not contain nuts.
If you have any of these conditions, you many NOT recieve cupping:
- cancer
- deep vein thrombosis
- open wounds
- bone fractures
- organ failure
- use of a pacemaker
- hemophilia
- acute infection
- use of any anticoagulants
- severe chronic disease (such as heart diseases)
- pregnancy
- anemia
- recent blood donation
- any recent medical emergencies
By signing below you agree to the following:
1) I give my permission to receive cupping therapy and light touch.
2) I understand that Yin + Cupping is not a substitute for traditional medical treatment or medications.
3) I understand that the massage therapist, Veronica Dye, does not diagnose illnesses or injuries, or prescribe medications.
4) I understand the risks associated with cupping therapy include, but are not
limited to:
• Superficial bruising
• Short-term muscle soreness
• Exacerbation of undiscovered injury
I therefore release the company and the individual massage therapist from all liability concerning these injuries that may occur during the cupping and yoga session.
5) I understand the importance of informing my massage therapist of all medical conditions and medications I am taking, and to let the massage therapist know about any changes to these. I understand that there may be additional risks based on my physical condition.
6) I understand that it is my responsibility to inform my massage therapist of any discomfort I may feel during the Yin + Cupping class so she may adjust accordingly.
7) I understand that I or the massage therapist may terminate the session at any time.
8) I have been given a chance to ask questions about the massage therapy session and my questions have been answered.