Gua Sha Release Form

Gua Sha Release Form

Gua Sha Contraindications

Gua Sha is not suitable for everyone. There are risks associated with performing Gua Sha on individuals with the following conditions.

You must inform your massage therapist/practitioner if you have any of the following conditions which may make Gua Sha contraindicated or may require the therapist/practitioner to alter the treatment.

• Bruises

• Pregnancy

• Diabetes

• Inflammatory skin conditions

• Open wounds, sores, or thinning skin

• Hypotension or Hypertension

• Cancer (with or without treatment)

• Varicose veins

• Under the influence of drugs or alcohol

• Blood clot(s)

• Cardiovascular disease

• Neuropathy

• Autoimmune condition (MS, Lupus, RA, etc.)

• Peripheral vascular disease

• Heat Sensitivity

• Compromised immune system

• Edema or Lymphedema

• Blood thinning medications

Client's Release

I have read and understand the aforementioned conditions which make Gua Sha contraindicated. The massage therapist/practitioner has discussed this information with me and provided the opportunity for any questions. I have disclosed any and all risk factors.

Please check the following that applies to you.

I understand that I will be receiving Gua Sha as an adjunct form of healthcare only and that this therapy is not meant to replace appropriate medical care. I understand the risks of bruising and muscle soreness that may occur directly or indirectly from Gua Sha treatment. I release the massage therapist/practitioner and business of any and all liability for any harm that may unintentionally occur during my treatment(s).