Massage Cupping Informed Consent Massage Cupping bodywork therapy is an adaptation of an ancient technique; the purpose of this technique is to promote health and healing by: loosening soft tissue and connective tissue, scarring and adhesions moving stagnation and increasing lymphatic flow and circulation. This therapy utilizes silicone or plastic cups and a vacuum pistol to create suction on the body surface. These cups are moved over the skin using gliding, shaking, popping and rotating techniques while gently pulling up on the cup, or may be parked for a short time to facilitate joint mobilization or soft tissue release. Suction reaches deep into the soft tissue, attachments and organs. Another benefit is to pull toxins and inflammation from the body to the surface of the skin where the lymphatic system can more readily eliminate them. Potential reactions to Massage Cupping are temporary and may include: - Cup Kiss: discoloration due to toxins and old blood being brought to the surface
- Post tenderness: usually less than experienced from deep tissue work
- Redness and Itching: increased vaso-dilation and/or inflammation brought to the surface
- Decreased Blood Pressure: due to vaso-dilation and/or nervous system sedation
Suggested after care recommendations: - Drink plenty of water, to help eliminate toxins out of the body.
- Avoid showers, steam, sauna and exercise immediately following bodywork.
- Light stretching and range of motion exercises are beneficial.
- Exercise the next day will help increase circulation to aid in fading of cup kisses.
Contraindications: People who are on blood thinners should not experience Massage Cupping. If you start taking such medication please inform the therapist so your treatment plan can be adjusted. If you are under the care of an acupuncturist, massage cupping could potentially interfere with acupuncture treatments, and should be avoided. MANJAE COSMETICS has provided me with information on the Massage Cupping bodywork technique. If I choose to experience this therapy in my treatment, I understand the effects and after- care recommendations. It has been explained to me that there is the possibility of a temporary skin discoloration or “cup kiss”, appearing as tissue is released. I am aware that a “cup kiss” is NOT a bruise and that it will dissipate within a few hours to a few days. I understand that all treatments by MANJAE COSMETICS are therapeutic in nature. I agree to notify MANJAE COSMETICS of any physical discomfort experienced during the session. I have stated all relevant physical conditions, and will inform MANJAE COSMETICS of any changes in my health. I have read through and answered honestly all of the below questions. All previous questions of mine have been answered and I understand the treatment in its entirety. INFORMED CONSENT FORM FOR MULTIPOLAR RADIOFREQUENCY TREATMENTS I understand that taking the treatment course is my choice and that I am free to withdraw at any time, without giving any reason. I understand that possible side effects of the treatment including: skin redness (erythema) and warmth. Although these effects are rare and expected to be temporary, any adverse reaction should be reported immediately. I understand that not everyone is a candidate for this treatment and results may vary. I confirm that I have read and understood the above information and will undergo the treatment out of my own free will. I believe I have adequate knowledge upon which to base an informed consent. Financial: I understand that all payments are due at time of service. To receive package prices, payment must be made for the entire package prior to service. Money for prepaid packages is non-refundable, however, credit for services yet-to-be delivered may be applied to receiving any other services or products offered at MANJAE COSMETICS (credits are calculated on non-package pricing). Cancellation of appointments without rescheduling must be done 48 hours prior the appointment to avoid treatment fee charges. I affirm that all information provided below is correct to the best of my knowledge. Precautionary Corona Virus Liability Release Form Due to the 2019-2020 outbreak of the novel corona virus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and sign below. Symptoms of COVID-19 includes: - Fever
- Fatigue
- Dry Cough
- Sore Throat
- Muscle Pain
- Headache
- Chills
- Difficulty Breathing
- New loss of Taste or Smell
I, Agree to the following: I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days. I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 30 days. I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days. I affirm that I, as well as all household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days. I understand that this business (D’Lux Artistry) and my PMU artist cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client. By signing below, I agree to each above statement and release the PMU artist and business from all liability for the unintentional exposure or harm due to COVID- 19. Your PMU artist and all employees if this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to fight the spread of COVID-19 and other communicable conditions more thoroughly.
Picture and Video Release Consent Form I, hereby grant Manjae Cosmetics LLC, its representatives, employees, and authorized personnel the irrevocable right and permission to use, reproduce, edit, display, distribute, and publish photographs, images, videos, audio recordings, and other media content in which I appear or participate. This consent extends to any medium, including but not limited to websites, social media platforms, promotional materials, advertisements, and any other marketing or promotional materials, for an indefinite period. I understand and agree to the following terms: Voluntary Participation: I acknowledge that my participation in any photographs, images, videos, or other media content is entirely voluntary and that I will not receive any compensation for the use of such content. Ownership and Rights: I acknowledge that all rights to the Content, including but not limited to copyright, remain the property of Manjae Cosmetics LLC. I hereby waive any claims to ownership or royalties related to the Content. Release: I release and discharge Manjae Cosmetics LLC, its representatives, employees, and authorized personnel from any and all claims, liabilities, demands, actions, causes of action, costs, and expenses arising out of or in connection with the use of the Content, including any claims for defamation, invasion of privacy, or infringement of any rights. No Approval Required: I acknowledge that I have no right to review or approve the Content before it is used, and I waive any right to inspect or approve such content. Consent for Minors: If the participant is a minor (under 18 years old), I am the parent or legal guardian of the minor participant, and I consent to the terms outlined in this form on their behalf. Revocation: I understand that I may revoke this consent at any time by providing written notice to Manjae Cosmetics LLC. However, any use of the Content prior to revocation will not be affected. Entire Agreement: This consent constitutes the entire agreement between me and Manjae Cosmetics LLC regarding the use of the Content and supersedes any prior agreements or understandings. By signing below, I acknowledge that I have read and understood the terms and conditions of this Picture and Video Release Consent Form and agree to be bound by them. Today's Date: September 22, 2023 |