Hijama Eligibility Screening - MedSphere Clinic

Client Information

Client Name *

Client ID *

Screening Date *

Email Address

STEP 1 — ABSOLUTE CONTRAINDICATIONS

If any of the following = Stop immediately

Bleeding disorder / clotting disorder

On anticoagulants (Warfarin / DOACs)

Severe anemia (known or recent)

Active skin infection or open wounds

Previous fainting with blood draw

Acute red-flag symptoms (chest pain, new neuro signs)

This condition will be flagged in the dashboard. Proceed with caution and clinical judgment.

STEP 2 — RELATIVE RISK SCORING

(Marks only if no absolute contraindications)

Condition	Marks
Pregnancy	+2
Extended fasting / dehydration	+1
Low blood pressure / dizziness	+1
No food eaten today	+1
Current illness / extreme fatigue	+1

TOTAL SCORE: 0 / 6

STEP 3 — FINAL DECISION

✅

SUITABLE

• Proceed as planned
• Wet or dry cupping as appropriate

⚠️

SUITABLE WITH MODIFICATION

• Dry cupping preferred
• Fewer cups / shorter duration
• Ensure food & hydration

❌

NOT SUITABLE TODAY

• Postpone session
• Advise rest, food, hydration
• Reassess another day

REMEMBER (MEMORISE THIS): 0 = YES ✓ 1 = MODIFY 3+ = NO TODAY