DEFIANCE (PIERCING) CONSENT FORM

DEFIANCE (PIERCING) CONSENT FORM
Client Information
Full Name*

First NameLast Name
Age*
16+ WITH GOVERMENT ID OTHERWISE NEED A PARENT TO ACCOMPANY
ID*

TYPE OF GOV IDID NUMBER
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of your booked appointment (Date and time given by piercer)*

MonthDayYear
Date
Time of your booked appointment *

:HourMinutesAM/PM Option
Yes my piercer confirmed the time and date of my appointment.
What are you wanting pierced*
Yes, I show no signsNo
YesNo
YesNo
YesNo
YesNo
CLIENT PROTOCOL

ALL CLIENTS MUST WASH HANDS WITH SANITIZER UPON ARIVAL.

ALL CLIENTS MUST WEAR A MASK. WITH EXCEPTIONS TO LIP/NOSE OR OTHER ORAL PIERCINGS.

(YOUR PIERCER WILL DIRECT YOU WHEN YOU ARE TOO REMOVE THE MASK FOR THE PROCEDURE)

IF CLIENT DOSN'T HAVE A MASK ONE WILL BE PROVIDED.

PLEASE DO NOT SHOW UP EARLY DOORS WILL BE LOCKED UNTILL SCHEDULED APPOINTMENT TIME.

PLEASE DO NOT BRING UNNECESSARY ITEMS WITH YOU.

IF CLIENT SHOWES SIGNS OF FLU SYMPTOMS THE APPOINTMENT WILL BE RESCHEDULED.

PIERCER PROTOCOL

WE ARE REQUIRED TO WEAR THE PROPER PPE WHICH CAN INCLUDE MASK, GOWNS AND ANYTHING ELSE DEEMED NECESSARY BY FRAZER HEALTH/WORK SAFE BC.

STAFF MUST SANITIZE ALL SURFACES AFTER EACH CLIENT.

STAFF MUST HAND SANITIZE BEFORE AND AFTER EACH CLIENT.

IF STAFF SHOWES SIGNS OF FLU SYMPTOMS THE APPOINTMENT WILL BE RESCHEDULED.
YesNo
Acknowledgment and Waiver
I UNDERSTAND THE STAFF AT DEFIANCE BODY STUDIO ARE NOT TRAINED MEDICAL PROFESSIONALS AND ADVICE FROM THEM ARE JUST SUGGESTIONS ALL DECISIONS AND ULTIMATELY MINE.

I UNDERSTAND I AM FULLY RESPONSIBLE OF THE AFTER CARE OF MY PROCEDURE WITH GUIDANCE OF THE PIERCER.

I AM AWARE THAT ALL PROCEDURES COME WITH RISK FACTER BEING POSSIBLE: INFECTION, MIGRATION, REJECTION, ECT.

I AM AWARE IF I REMOVE OR THE JEWLRY COMES OUT I AM FULLY RESPONSIBLE FOR THE HEALING AND RE-PIERCING COST

I AGREE TO NOT SEEK ADVICE FROM OTHER PIERCERS REGARDING PROCEDURES DONE AT DEFIANCE BODY STUDIO.

I AGREE I HAVE NOTIFIED MY PIERCER OF ANY AND ALL HEALTH CONCERNS AND MEDICATIONS (BLOOD THINNERS, ECT)
YesNo
Yes
PARENT OR GUARDIAN (IF REQUIRED)

First NameLast Name
Signed Date*

MonthDayYear
Date
Client Signature (OR GUARDIAN)

Clear
Should be Empty:

DEFIANCE (PIERCING) CONSENT FORM

Client Information

Acknowledgment and Waiver