Dermal/Surface/Genital Piercing Consent Form

  • Dermal/Surface/Genital Piercing Consent Form

  • Client Information

  • Pronouns
  • Format: (000) 000-0000.
  • Birthdate*
     / /
  • Client ID
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  • Pre-Procedure Questionnaire

  • Do you have any history of herpes infection, diabetes, allergic reaction to latex or antibiotics, hemophilia, or other bleeding disorder or cardiac valve disease?*
  • Have you taken antibiotics within the past two weeks?*
  • Do you have any medical conditions/communicable diseases?*
  • Do you take any medications?*
  • Are you currently under a doctor's care for a continuing condition?*
  • Do you have any conditions that may affect the application or healing of the body piercing?*
  • Are you prone to fainting?*
  • Are you pregnant or breastfeeding?*
  • Are you prone to heavy bleeding or have you taken aspirin, ibuprofen, or blood thinners with the last 24 hours?*
  • Have you consumed any food within the last 2 hours? We recommend staying nourished to sustain your energy. Please let your body artist know if you would like to take a break.*

  • Acknowledgment and Waiver

    Please check all boxes below to agree.

  • General Piercing Aftercare

    • WASH your hands thoroughly prior to cleaning your piercing for any reason.
    • SOAK with saline solution twice a day for the next 4-6 months during the initial stage for 5-10 minutes. For certain placements, it may be easier to apply using clean gauze or paper towel saturated with saline solution.
    • DRY by gently patting with clean, disposable paper product. Cloth towels harbor bacteria and can snag on jewelry.
    • INSPECT jewelry ends for tightness. For threaded ends: twist clockwise. For threadless jewelry: press together.

    What to Expect

    • Initially some bleeding, localized swelling, tenderness or bruising.
    • During healing you may see some discoloration, itching, secretion of a whitish-yellow or light green fluid that will form "crusties" on the jewelry.
    • A piercing may seem healed before the healing process is complete. This is because tissue heals from the outside in and although it feels fine the interior remains fragile. Be patient and keep cleaning throughout the entire healing period.

    What to Avoid

    • Physical activities such as bathing, recreational water activities, gardening, or contact with animals for three months.
    • Moving jewelry around in an unhealed piercing and/or picking dried discharge with your fingers.
    • Cleaning with other products that are not sterile saline, i.e alcohol, peroxide, Bactine, Neosporin, and tea tree oil.
    • Over cleaning. This can delay your healing cycle and irritate your piercing.
    • Contact with other's bodily fluids and rough play with jewelry while healing.
    • Submerging in unhygienic bodies of water such as lakes, pools, hot tubs.
    • Piercings can be protected using waterproof bandages.
    • Using personal care products on or around piercings including cosmetics, lotions, and sprays.

    Signs/Symptoms that Indicate the Need to Seek Medical Care

    • Signs and symptoms of infection, including, but not limited to, redness, swelling, tenderness of the procedure site, red streaks going from the procedure site towards the heart, elevated body temperature, or purulent drainage from the procedure site.

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