Hijama (Wet Cupping) Therapy – Client Consent Agreement

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✅ Section A – Client Declaration

As a client of All About Hijama, I confirm and acknowledge the following:

1. Understanding the Therapy

Hijama (wet cupping) is a complementary therapy rooted in the Sunnah of the Prophet Muhammad ﷺ. It involves applying suction cups to specific areas of the body, followed by small incisions to remove stagnated or potentially harmful blood.

I understand this therapy is holistic, aims to support detoxification and spiritual balance and is not a substitute for medical care or diagnosis.

✅ Section B – Medical Fitness Statement

I confirm that I am fit to receive Hijama therapy and that none of the following apply to me:

• Blood clotting disorders (e.g. haemophilia, DVT, thrombocytopenia)
• Use of blood thinners (e.g. Warfarin, Heparin, Clopidogrel, Aspirin)
• Uncontrolled high or low blood pressure
• Heart conditions, pacemaker or recent stroke
• Liver or kidney failure
• Active or recent cancer (within the past year)
• Uncontrolled diabetes or insulin shock history
• Autoimmune disorders unless stable and approved by GP
• Epilepsy or recent seizures
• Chronic anaemia or low iron levels
• Skin conditions or infections (e.g. eczema, psoriasis, boils) in cupping areas
• Keloid scarring tendency or delayed wound healing
• Current infections including COVID-19, cold, flu or fever
• Contagious diseases or bloodborne viruses (e.g. hepatitis, HIV)
• Recent surgery or open wounds
• Pregnancy or recovery from recent childbirth
• History of fainting or poor tolerance to blood

I also confirm I am not under the influence of drugs, alcohol or sedatives and I am not unwell at the time of this treatment.

If any of the above conditions apply now or in the future, I understand it is my responsibility to inform the practitioner before treatment.

✅ Section C – Possible Risks and Side Effects

I understand and accept that while Hijama is generally safe when performed correctly, it may involve the following temporary side effects:

• Local bruising or swelling
• Mild bleeding or spotting
• Skin sensitivity or scarring
• Light-headedness, nausea or fatigue
• Detox symptoms (headache, thirst, tiredness)
• Risk of infection if aftercare is not followed

I confirm I have been informed about these risks and the steps taken to minimise them through the use of single-use sterile equipment, hygienic practices and professional care.

✅ Section D – Aftercare Responsibility

I accept responsibility for following all aftercare advice provided, including:

• Rest for 12–24 hours
• Avoiding sexual relations, intense activity or cold exposure for 24 hours
• Keeping cupping areas clean, dry and covered
• Drinking plenty of water to flush toxins
• Using natural ointments if needed

If I feel unwell after treatment, I will inform the therapist and seek medical advice if necessary.

✅ Section E – Islamic Conduct and Ethics

I acknowledge that Hijama is a Sunnah practice and that:

• The therapist will observe full Islamic etiquette and confidentiality
• For female clients, a female therapist will conduct the treatment in privacy
• Modesty and dignity will be protected at all times
• No images or recordings will be taken without my explicit consent
• My intention is to seek healing through means prescribed by the Prophet ﷺ while placing my trust in Allah for the outcome

✅ Section F – Confidentiality and Data Use

I consent to All About Hijama collecting and securely storing my personal and health information for treatment and aftercare purposes.

• My information will not be shared without my consent unless required by law
• I can request access to or deletion of my data at any time
• I am happy to be contacted for follow-up, reminders or check-ins

✅ Section G – Consent and Waiver

By clicking consent button below and click the link provided to my email address, I confirm the following:

• I have read and understood this document in full
• I have no known medical condition or infection that makes Hijama unsafe for me
• I understand the risks and accept full responsibility for my participation
• I have had the opportunity to ask questions and have received clear answers
• I consent to receive Hijama therapy from All About Hijama Liverpool
• I release the therapist from liability except in the case of proven negligence

By writing your email address and clicking the link provided to you email, you consent the form stated above.