# Cupping Consent Form Template

> A free cupping consent form for wellness spas, massage and holistic practitioners. Clients share health notes, learn about marks and sign before treatment.

A cupping therapy consent form with a short health check, the areas to treat and sample terms about marks, aftercare and stopping at any time. Clients sign online and you keep a signed PDF.

Canonical: https://reuily.com/templates/cupping-consent-form
Use this template: https://reuily.com/form/from-template/cupping-consent-form
Collections: Agreements & Waivers, Beauty & Wellness, Holistic Wellness
Last updated: 2026-10-24

## Questions

- Question 1: What's your full name? (Short Text, required)
- Question 2: What's your email address? (Email, required)
- Question 3: What's your phone number? (Phone, required)
- Question 4: Have you had cupping before? (Yes / No, required)
- Question 5: Which areas would you like treated? (Multiple Choice, required). Options: Upper back; Lower back; Shoulders; Neck; Legs; Not sure
- Question 6: Do any of these apply to you? (Multiple Choice, optional). Options: Pregnant; Taking blood thinners; Skin condition or sunburn; Bleeding disorder; Recent surgery; None of these
- Question 7: Is there anything else your practitioner should know? (Long Text, optional)
- Agreement: Cupping consent, accepted with "I agree" (full text below)
- Question 8: Sign the cupping consent (Signature, required)

Signing records the signer's consent, email, IP address, browser and signing time, and each signer can download a signed PDF copy.

## Cupping consent

Please read this before you sign.

This agreement is between **[Business name]** (the "Practitioner") and the client named in this form.

1. **What cupping is.** Cups create suction on the skin for relaxation and muscle tension. It is not medical care and does not replace care from a doctor.
2. **Marks.** Cupping often leaves round marks that can last **[number]** days. They are expected and usually fade on their own.
3. **Other effects.** The client may feel tender, tired or lightheaded after treatment.
4. **Health.** The client has shared any health details that matter and will tell the Practitioner if anything changes.
5. **Stopping.** The client may ask to lower the suction or stop treatment at any time.
6. **Aftercare.** The client will follow the aftercare advice given, such as drinking water and keeping the area warm.

By signing below, I confirm that I have read this consent and agree to it.

## Common uses

- Wellness spas
- Massage therapists offering cupping
- Holistic practitioners

## Key features

- Treatment areas
- Health check before treatment
- Signed consent as a PDF

## Frequently asked questions

### What should a cupping consent form include?

A health check, areas to treat, and terms about marks, other effects, stopping at any time and aftercare. This template includes each one as a sample to start from, not legal advice.

### Who uses a cupping consent form?

Wellness spas, massage therapists and holistic practitioners who offer cupping, on its own or as part of a massage.

### Can clients sign before they arrive?

Yes. Send the link with the booking confirmation so clients sign at home, and your practitioner reads the notes before treatment.