• CUPPING THERAPY CONSENT FORM

    CUPPING THERAPY CONSENT FORM

  • Cupping is a therapy that applies negative pressure on the skin using plastic or silicone cups. The suction created by these cups 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.

    Here are some cases where we do not do cupping:

    • Skin Lesions or Inflammation (already present)
    • Organ Failure (Renal, Hepatic, and/or Cardiac)
    • Hemophilia or similar bleeding disorders
    • Cancer
    • Varicose Veins, Spider Veins

    Caution should be taken with any the following conditions, please talk with your practitioner if you are experiencing any of these:

    • Diabetes with complications
    • Pregnancy, the first 6 weeks after giving birth or menstruation
    • Lymphedema
    • New Tattoos (localized)
    • Heart Disease 
    • Recently given blood or undergone a medical procedure

    I understand and am aware that....

    • Cupping may result in marks being left on my body and these marks can take anywhere from a few hours to up to two weeks to dissipate
    • Cupping marks are/can be considered bruises
    • Cupping marks may or may not be tender to the touch and that I will inform my practitioner if I am uncomfortable at any time during my treatment
    • If I am receiving facial cupping (for cosmetic, TMJ issues, headaches, sinusitis, Bells Palsy, Trigeminal Neuralgia, etc) that in order to treat these conditions most effectively, cups may be left in one place for up to 2 minutes. Depending on my skin type I understand this type of treatment may leave cupping marks on my face.
    • There can be side effects to cupping such as nausea/vomiting, fainting, blisters/infections, bleeding, bruising, headaches, dizziness, fatigue, and others.
  • I consent to allow Caitlyn Cruz, the Cupping Practitioner/Massage Therapist to perform Cupping Therapy. I understand the benefits, side effects, contraindications, and the possibility of cupping marks as part of the massage and will not hold the Massage Therapist responsible. I have asked all necessary questions and have had any concerns addressed.

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