Book Appointment

Open all week including Weekends & Holidays

Female & Male Practitioners

Located in Greenfield, WI

To request an appointment, please fill the following fields:

If you are human, leave this field blank.

First Name *

Last name *

Phone *

Email *

Age *

Client Gender *

Female

Male

Choose the gender of your Hijama Practitioner *

Female

Male

Either

Do you smoke, inhale or use nicotine pouches? *

No

Yes

Are you currently Pregnant? *

No

Yes

Are you experiencing Irregular Menstrual Cycle? *

No

Yes

Requested Date *

Requested Time *

First time Hijama in general *

Yes

No

First time Hijama in our practice *

Yes

No

Reason why interested in Hijama: *

List all the medicine & supplements you take here:

Write all your medical history here including previous surgery or injury:

Requested Hijama Package *

Hijama (Standard) $90.00 (Recommended for Sunnah & Maintenance)

Hijama Cleanse (Detox) $110.00

Hijama Plus $140.00 (Recommended for: Additional body regions such as Knees, Shoulder or Head - Athletes - Negative Spirituality)

Not Sure

Are you experiencing: Fever, Chills, Cough, Shortness of breath, Difficulty breathing, Sore throat, Congestion, Nausea, Vomiting or Diarrhea? *

No

Yes

I read, understood and consent to the below waiver & disclaimer. By signing here, I agree that the information submitted above is complete and correct.

Waiver & Disclaimer

Signature *

Reset Signature

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We accept Cash payments. Checks are not accepted. Credit/ Debit Cards, PayPal and Zelle are accepted at an extra cost of 5% charged to the client.

Fee covers (Equipment Cost, Operational Fees, Biomedical Waste Disposal Fees, Monthly License Fee, Monthly Insurance Fees and compensation for the therapist time)

2023 Monthly Islamic Calendar

https://chicagohilal.org/calendar/

https://www.islamicfinder.org/islamic-calendar/

For inquiries and questions, Don’t hesitate to call us on 414-241-4942

Hijama is not defined or presented as a Medical procedure, Medical treatment or Medicine.