Hijama for Sisters by Sis Izyan Please be advised that this activity is for SISTERS ONLY PERSONAL DETAILSName*Please enter your Full Name (As per IC / Passport)Age*IC / Passport No.Email* Phone*Emergency Contact*Phone NumberIs this your first time undergoing hijama (cupping) therapy?*YesNoList any conventional or unconventional medications, herbs and therapies you are currently trying (if any):E.g. Acupunture, Acupressure, Homeopathy, Naturopathy, Chemotherapy, Dialysis, Chiropractic MEDICAL INFORMATIONPlease mark any of the listed conditions you may have: Broken Bone Surgical Incision Organ Failure Insulin Monitor Cancer Varicose Veins Pregnancy Skin Disease Appendix Hernia Dislocation Hemophilia Hearing Aid Slipped Disc Fever Diabetes Sunburn Kidney Illness High/Low Blood Pressure Ulcerated Skin Cardiopathy Pacemaker Joint or Bone Replacement Other(s) Other(s), please specify BOOK YOUR SLOT Please note that the exclusive packages use single-use cupsTreatment*Full Body Hijama (24 Cups) Half Body Hijama (15 Cups) Migraine Hijama (7 Cups) Facial Hijama (8 Cups) Full Body Massage (w/ Dry Cupping) Therapist*Nur Izyan Exclusive Package Exclusive Package Additional charges Price: RM 20.00 Additional charges Price: RM 15.00 Additional charges Price: RM 10.00 Additional charges Price: RM 10.00 Book your slot* March 2021 Mon Tue Wed Thu Fri Sat Sun 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 March 11, 2021 10:00 AM 11:30 AM 2:00 PM 3:30 PM 5:40 PM March 12, 2021 10:00 AM 11:30 AM 2:00 PM 3:30 PM 5:40 PM March 18, 2021 10:00 AM 11:30 AM 2:00 PM 3:30 PM 5:40 PM March 19, 2021 10:00 AM 11:30 AM 2:00 PM 3:30 PM 5:40 PM March 25, 2021 10:00 AM 11:30 AM 2:00 PM 3:30 PM 5:40 PM March 26, 2021 10:00 AM 11:30 AM 2:00 PM 3:30 PM 5:40 PM PriceRM 0.00Total RM 0.00 Payment Method*Online Transfer (FPX)ATM / Direct Transfer Please transfer the total amount to: 5623 5711 4347 FOQUS AKY SDN BHD (Maybank) Keep the payment slip and upload it below:Upload Proof of Payment*TERMS & CONDITIONSNEW NORMAL We will be observing the following SOP in accordance to what has been set by the authorities: Only registered attendees can enter All attendees must wear face masks Scan “Selangkah” QR code before entering Get temperature checked by staff in charge (Must be below 37.5°C) Maintain social distancing (1 metre) - avoid handshakes and body contact Stand on the designated line while queuing Wash hands / Use the hand sanitizer provided before entering Please note that we have the right to refuse admission if: Attendee fails to follow our SOP Attendee body temperature exceeds 37.5°C We have reached maximum capacity for the day Agreement to terms & conditions* I hereby acknowledge that I have read, understood, and agree to all that have been stated and that all the information I have given is true.1. Your placement is only confirmed when payment is fully paid 2. Placement is by first come first serve basis 3. Any payment made will not be refunded 4. Upon confirmed registration and payment, we will email you the confirmation and receipt 5. For further clarification please contact Sis Izyan Amin via WhatsApp: +60196990403 6. You will adhere to the New Normal SOP set by Al-Khaadem at all times whilst being in our centre 7. CUPPING THERAPY INFORMATION SHEETPROCEDURE In this session, the client will be treated with a warm up massage, followed by dry cupping, cupping massage, and blood cupping/hijama therapy. - A body massage and vibration therapy are done to improve blood circulation and fluid drainage, to loosen and soften muscles, and to relax the patient. - Dry cupping is performed by applying cups to the body according to the Sunnah points. The air in the cups are then sucked out to create a vacuum. This is to release tight muscles and improve circulation. - Cupping massage is done by sliding the cups on the body to further improve the effects of cupping and massage. - In blood cupping/hijama, the therapist punctures the skin slightly to draw a small amount of blood, and then places the cup on the patient’s body. The skin is punctured to allow toxins to leave the body. The cups are left on the skin for several minutes, then removed and cleaned. POTENTIAL EFFECTS -Cupping may cause pain, swelling, dizziness, light-headedness, fainting, sweating, skin pigmentation, and/or nausea. - Cupping also leaves round purple marks or circular discolorations on the skin; these marks may begin to fade after several days but can remain for two to three weeks. CONTRAINDICATIONS - Cupping shouldn't be done on areas where the skin is broken, irritated, or inflamed, or over arteries, veins, lymph nodes, eyes, orifices, or any fractures. - Pregnant and breastfeeding women, children under the age of 12, seniors over the age of 70, and people with certain health conditions (such as cancer, organ failure, haemophilia, oedema, blood disorders, anaemia and some types of heart disease) are among those who shouldn't have cupping. - People taking blood-thinning medication or anti-clotting medication such as Aspirin, Rivaroxaban (Xarelto), Dabigatran (Pradaxa), Apixaban (Eliquis), Heparin (various), Warfarin (Coumadin), etc. - People recovering from surgery. - People with a history of cancer, diabetes, heart attacks, chronic hypertension and asthma attacks. 8. ConsentI hereby give my voluntary consent for the administration of Cupping/Hijama therapy deemed appropriate by my treating therapist. I understand that all treatments in this facility are therapeutic in nature. I agree to communicate to the therapist any physical discomfort or draping issues during the session. Information has been provided to me about Cupping Therapy in the Cupping Therapy Information Sheet. 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 therapist, including those not mentioned on my Client Registration 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 my 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 cleared 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, 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. Water helps to dilute the intensity of the release. I understand that Cupping Therapy modalities should not be combined with aggressive exfoliation, 4 hrs after shaving, after sunburn or when I'm hungry or thirsty. I understand that I should avoid exposure to cold, wet, and/or windy weather conditions, hot showers, baths, saunas, hot tubs and aggressive exercise for 4 - 6 hours. I understand that exposure to such extremes can produce undesirable effects and I should avoid such situations. 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 the therapist 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 the practitioner responsible. I will immediately notify the therapist of any changes in my medical status. I will have the opportunity to discuss with my Physiotherapist the nature and purposes of all my treatments. I am aware that I may withdraw this consent and discontinue treatment at any time. I consent to the cupping therapy treatments offered and recommended to me by my therapist. I intend this consent to apply to all my present and future care.