Hijama/Wet Cupping Consent Form

In this document:

(a)  “Hijama” is the Arabic word for wet cupping, and refers to the process of raising the blood toward the skin and is then drawn by vacuum from a small skin incision for therapeutic purposes;
(b)  the singular includes the plural and vice-versa;
(c)  any reference to one gender includes a reference to all other genders;
(d)  any reference to “you”, “your” and “patient” refers to the patient receiving treatment; and
(e)  any reference to “us”, “we”, “clinic” and “therapist” refers to the staff of Masnad Health Clinic ABN 53 154 222 367 authorised to provide Hijama treatment.

ADVISORY BEFORE CONSIDERING HIJAMA

You must not rely on a Hijama therapist as an alternative to medical advice from your doctor or any other professional or medically licensed healthcare provider and medical advice must be sought prior to receiving Hijama treatment.

You should never; delay seeking medical advice, disregard medical advice or discontinue medical treatment because of your Hijama treatment.

You are responsible for discussing your suitability for Hijama therapy, with your licensed medical healthcare provider. If you have not done so and choose to proceed with Hijama treatment, you must assume responsibility for all medical risks arising thereof.

Hijama therapy is not suitable for pregnant females. Children under the age of 16 cannot receive Hijama without informing their doctor first.

ANAEMIA

Anaemia means that either the level of red blood cells or the level of haemoglobin is lower than normal, which deprives the body of adequate oxygen.

If you are severely anaemic, you must notify your therapist and not proceed with Hijama treatment.

RISKS AND SIDE EFFECTS

Whilst Hijama therapy has no major side effects and is a traditional technique that has been used for many centuries, there may be some side effects that you should know about and understand prior to receiving Hijama treatment.

All patients must understand and accept the possibility that there may be marks left on their body, which may last from a few weeks and several months. These marks might have the appearance of circular bruises or discolourations where the cups were applied. There may be some discomfort due to the method of skin cuts to the patient. You may feel worse for a few days following treatment and an increase in pain in certain areas of your body, as it adjusts and recovers. Other possible side effects include light-headedness, which may be similar to the sensation one feels after having had blood taken by a doctor, as Hijama therapy encourages blood flow to the cupped region (hyperaemia). One may therefore feel warmer and hotter as a result of vasodilatation (the widening of blood vessels) taking place and slight sweating may occur. There is a sound scientific rationale for this and there is no cause for concern.

LIMITATION OF LIABILITY

The patient acknowledges and agrees that the Hijama therapist and Masnad Health Clinic cannot accept any liability or expenses resulting from any illness, injury or other untoward occurrence arising from today’s Hijama treatment other than to the extent that death or personal injury arises as a result of negligence.

ACKNOWLEDGEMENT

To the best of my knowledge I confirm that my mental and physical health and fitness is good and that the information I have provided in this consent form is a true and accurate description of my medical history and current condition. I understand that by giving false information, I endanger both my own safety and the therapist.

Prior to this treatment, I have informed my Doctor regarding receiving Hijama treatment. I agree for the information in this form to be used by Masnad Health Clinic and its related entities for research and quality purposes.

Please note: If, after reading this page you have any questions, please contact Masnad Health Clinic on 02 9793 8840 or speak directly with our staff.

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