Piercing Consent Form
Name
*
First Name
Last Name
D.O.B
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of appointment
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Any allergies/medical conditions? If no please state N/A
*
Body part to be pierced:
*
I acknowledge that by signing this consent form, I have been given a full opportunity to ask any and all questions I have. I understand that it is my responsibility to follow the aftercare instructions as provided. I have disclosed all relevant information regarding allergies, medical conditions, etc., upon completing this form.I voluntarily give my full consent to the body piercings carried out by the practitioner. I am informed about the possible side effects and complications of body piercing procedures. I understand and agree that it is my responsibility to read and follow the instructions about procedures and aftercare detailed on the Savannah Studios website. I confirm that the information I have provided in this consent form is complete and accurate. I release the shop, its administrators, practitioners, stakeholders, and workers from any and all claims, expenses, liabilities, and damages.
*
Submit
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