Hijama Intake Form

Do Any apply?

Have you had hijama beforeAny adverse reactions?Have any body work treatments?
Please elaborate
Why are you having hijama therapy?
Is there anything else we should know about you?
Highlight any areas of pain
I give consent to wet and dry cupping. I have understood the before care and after care procedure. I have answered this health form fully to the best of my knowledge. I will advise the practioner of any change in my health and or medication and I give consent to have wet and dry cupping done.
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Highlight any areas of pain