FOREVER FRIENDS LINKED PERMANENT JEWELRY. CONCENT FORM.
PERMANENT JEWELRY IS A PROCESS THAT INVOLVES THE USE OF A WELDER. JEWELERY IS WELDED TOGETHER WHILE ON YOUR BODY. THE PROCEDURE IS PAINLESS AND IS PERFORMED WITH YOUR SAFETY IN MIND. THIS CONSENT FORM IS INTENDED TO INFORM YOU OF THE RISKS OF THE PROCEDURE AND TO OBTAIN YOUR CONSENT FOR THE PROCEDURE.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
I understand that although rare, an allergic reaction to the jewelry can occur.
YES
NO
I understand that the welding procedure does have some risks, including but not limited to potential allergic reaction, irritation, discomfort, burns, and scarring, a bright/spark from the welder. That you will wear eye protection provided for your safety
YES
NO
I agree to the jewelry care and cleaning instructions, to prevent tarnishing. Recommended by your echniciam
YES
NO
I understand that although this jewelry is intended to be permanent, durable and long- lasting the length of wear can vary depending on my physical activity and other factors. If a piece is snapped or broken bring to your jeweler for reconnection for a small fee.
YES
NO
I understand there may be times where i will be required to remove my jewelry including but not limited to medical procedures, like MRI. You can use scissors to remove and bring to your jeweler for reattachment, for a small fee.
YES
NO
I give the technician/jeweler permission to photograph my jewelry and procedure for their own marketing and promotional purposes.
YES
NO
I acknowledge that that by completing this form to the best of my knowledge i have asked all questions to my and concerns with my jeweler. I understand the risks and potential side effect That results can vary from person to person If i am under 18 I have parental consent I will not hold the technician/jeweler, salon or employees liable for any issues not disclosed at the time of service for any adverse effects from the permanent jewelry procedure. This agreement stays in effect for this procedure, and all follow up appointments.
Please verify that you are human
*
Signature
Lots of love Kelly, your forever friend xoxo
314315-7898
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