PIERCING CONSENT FORM

PIERCING CONSENT FORM
NAME

First NameLast Name
DATE OF BIRTH

MonthDayYear
Date
PHONE NUMBER
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL
example@example.com
Address

Street Address

CityState / Province

Postal / Zip Code
I voluntarily give my full consent to body piercings carried out by LARC Artistry. I am informed about possible side effects and complications of body piercing procedures such as infection and swelling. I understand and agree that it is my responsibility to read and follow the instructions about procedures and aftercare.

I confirm that the information that I provide in this consent form is complete and accurate.
Please acknowledge the following items:
Signature
Signed Date

MonthDayYear
Date
Should be Empty: