Contraindications:
People who are on blood thinners should not experience Myofascial Cupping Massage. If you start taking such medication please inform the therapist so your treatment plan can be adjusted.

*I am on blood thinners (Treatment is not recommended)
*I am on blood thinners, but my condition is under control and my Dr has approved Myofascial

Please check the boxes below as you read through each statement:
*I understand there are no guarantees regarding its use and effects and that I am free to stop the cupping treatment at any time.
*I understand that cupping commonly leaves marks on the skin that vary in pattern and colour (from light to dark purple) and usually last 3 days to a week, and sometimes longer

Accuracy of Information:
I certify that the above medical information is correct to my knowledge and have disclosed any & all health risk factors.

Client’s Release
-I understand and acknowledge that cupping is performed by suction at certain points on the body in attempt to treat bodily dysfunction, to modify or prevent pain perception, and to normalize the body’s physiological functions.

-I am aware and acknowledge that certain adverse effects may result. Including but not limited to: local bruising, pain or discomfort or possible aggravation of symptoms existing prior to cupping treatment.