Adult | 18+ CONSULTATION FORM

Full Name*

First and Last name

DOB:*

Date

Date of Appointment :

Date

City*

State*

Zip*

What is your instagram handle ?:

Cell Phone*

Email*

example@example.com

Medical Allergies(Allergic to metals)*

Do you have a pacemaker ? If yes, consult with your doctor before proceeding.*

YesNo

Taking any Medications

Emergency Contact Name*

Phone number*

Type of Jewery*

BraceletAnkletRepairOther

Type of Material*

14k Solid GoldGold Filled (Not Solid Gold)Sterling SilverOther

Method:

Welding, Clasp

Other Information

Thank you for choosing our jewelry bar to create your permanent jewelry. In order to provide you with the best possible service and ensure your safety, we require that you complete this Intake and Consent Form.

Please read this form carefully and sign it to indicate that you understand and agree to the terms and conditions outlined below.

I have voluntarily elected to undergo this appointment after the nature and purpose has been explained to me, along with the risks and hazards involved, by Artsy Color Lounge.

By signing this form, I acknowledge that there are inherent risks involved with welding permanent jewelry. These risks include but are not limited to burns, discomfort, allergic reactions, and potential scarring, and I accept any such risks.

I agree to provide accurate and complete information about my health history, including any medical conditions, allergies, or medications that may affect my ability to undergo the welding

By signing this form, I release Artsy Color Lounge and its employees from any liability for any harm, discomfort, or injury that may occur during the welding process. I also acknowledge that any injury or harm that results from the welding process is solely my responsibility.

I acknowledge that I have received and understand the aftercare instructions for the permanent jewelry, and agree to follow them as directed.

CANCELLATION & NO SHOW POLICY:
In order to continue providing the best possible scheduling options to my guests, I require 48 hours notice should you need to cancel or reschedule your visit with me. Should you cancel your appointment with less than 48 hours notice, a 50% cancelled fee will be charged to the card on file. If you cancel within 24 hours a 100% last minute cancellation fee will be charged to the card on file.

RUNNING LATE :
If you are later than 15 minutes, we may have to reschedule your appointment , this will be considered a missed appointment and the $30 or $60 retainer will be used to cover.

Retainer fee For Permanent Jewelry :
$30 or $60 retainer is due at the time of booking.
Retainers are non-refundable however, if we receive proper notice we can move the retainer to another appointment. If you are over 15 mins late to your appointment we will use the 60to cover the missed appointment. New retainer will be needed to schedule another appointment.

All sales are final no returns or exchanges not responsable for lost chains.

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND ALL THE INFORMATION IN THIS AGREEMENT AND I COMPLETELY UNDERSTAND IT BY SIGNING BELOW

Full name *

Phone number*

Preferred pronoun*

Guest Signature*

Date*

Date

ARTSY COLOR LOUNGE

CONSULTATON FORM

PERSONAL INFORMATION

APPOINTMENT INFORMATION

Consent Form