Cupping Therapy Client Release Form
    - Information has been provided to me about CUPPING THERAPY. If I choose to experience these therapies during treatments, I understand the potential effects and after-care recommendations.

    - It has been explained to me that there are contraindications for CUPPING THERAPY. I have fully disclosed all health factors to my massage therapist, including those not mentioned on my Health History Intake Form, to avoid any complications.

    - It has been explained to me that there is the possibility of discolorations that can occur from the release and clearing of stagnation and toxins from the body.

    - I also understand that this reaction is not bruising, but due to cellular debris, pathogenic factors and toxins being drawn to the surface to be clear away by my circulatory system.

    - I further understand that the discolorations will dissipate from a few hours to as long as 2 weeks in some cases and in relation to my after-care activities.

    - I understand that the first time I experience CUPPING THERAPY, my body's immune system can temporarily react to this release as it might with the flu - producing flu-like effects like nausea, headache, aches, that will subside in time with rest and water.

    - I understand that CUPPING THERAPY should not be combined with aggressive exfoliation, 4 hours after shaving, after sunburn or when I am hungry or thirsty.

    - I understand that I should avoid caffeine, alcohol, sugary foods and drinks, dairy and processed meats and I should consume an abundance of clean water.

    - I agree to allow Myriam Desrosiers, LMT, CCT to perform CUPPING THERAPY. I also agree that I have read, understand and will follow all of the information stated above and will not hold Myriam Desrosiers, LMT, CCT responsible.
Corner Canyon Massage Therapy - 12441 S 900 E suite 255 Draper, UT 84020 - (303) 960-8616
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massage in Draper UT