We appreciate your interest in Hijama.

Our services are provided ONLY by appointments. Please fill out the form given below for requesting a Hijama cupping appointment from Atlanta Hijama.

We provide detailed instructions to prepare for Hijama prior to having a session of therapy.

Please fill in the information as thoroughly as possible.

EACH PERSON interested must send a separate completed form.

JazakaAllahu Khaira Was-Salam.

APPOINTMENT REQUEST FORM

Full Name: *

Male / Female: *

Age *

Religion *

Sect *

Mobile (Cell) Phone *

Home Phone *

Email Address *

Postal Address *

How did you hear about us *

Have you had Hijamah done on yourself before *

If yes, please provide details:

What are the main concerns or reasons that are making you consider Hijamah *

Do you have any health conditions / sicknesses (Physical / Psychological) *

If Yes, Please provide details about your Physical / Psychological health

Do you have or do you think you might have effect of any spiritual/supernatural issues (i.e. magic / Sihr, Jinn, Evil Eye etc) *

If Yes, Please provide details about your spiritual health

Which days and timings are best for your schedule *

Anything else that you want us to know *

Message

Disclaimer
The procedures administered by Atlanta Hijama are non-medical. They are not intended to treat or correct any human ailments, symptoms or conditions of any kind. Only your licensed physician can provide medical treatments.This is strictly religious and holistic remedy, per guidelines of Sunnah of Prophet Muhammad (S.A.W).

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APPOINTMENT REQUEST FORM