Dry Cupping Consent

Please read the form below carefully.

Consent *

I, the undersigned, acknowledge that I have read and understood the following information regarding dry cupping therapy:

1. Procedure

Dry cupping involves placing cups on the skin to create suction. Cups may be left stationary or moved (gliding) over the skin.

2. Side Effects

I understand that common side effects include:

Temporary circular marks on the skin, which usually fade within 1–2 weeks. Mark intensity may vary depending on individual skin type, circulation, and suction intensity.
Mild soreness or tenderness in the treated area
Temporary fatigue or lightheadedness

3. Health and Contraindications

I confirm that I have previously completed a health form for massage and have disclosed all relevant medical information. I understand there are no medical conditions that make cupping unsafe for me.

4. Consent

I voluntarily consent to dry cupping therapy. I understand the potential risks and have had the opportunity to ask questions.

Full Name *

Today's Date *