Page 4 Cupping Risk Disclosure (Sign here) ---

 

Cupping Risk Disclosure – Stationary Cups, < 10 min, Home Use

 

• Method: Stationary negative pressure cups (no fire cupping). Each
session < 10 minutes.

• Common reactions: Circular marks, bruising, mild tenderness (normal,
resolves in days to a week).

• Less common: Blisters, minor skin breaks, temporary pigmentation changes.

• Home care: Avoid showering or bathing for 4 hours after cupping. Do
not puncture blisters. Keep area dry. If signs of infection (increased
redness, swelling, heat, pain) appear, seek medical care.

• Obligation to disclose: I understand that if I have bleeding
tendencies, skin infection, extreme weakness, severe heat disease, or
take blood thinners, I must inform the practitioner before cupping.

 

I have read and agree to the above.

Patient signature: _____________________

Date: __________________