Piercing Consent Form

Piercing Consent Form
I voluntarily give my full consent to body piercings carried out by the practitioner. 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:

I do not have symptoms of COVID-19 and accept to follow the rules of the shop during my appointment.I have not contacted to anyone who may have symptoms of COVID-19 or get infected by the virus within 14 days.I understand that I am responsible for the any touch-up work due to my fault, negligence or carelessness.I understand that there is a possibility to get an infection if I do not follow the instructions.I am not under the influence of alcohol or drugs, and I am voluntarily submitting to body piercing without duress or coercion.I understand that the procedure causes a permanent change to my skin and body.I do not have any mental or medical disability that may affect my wellbeing as a result of having this piercing procedure.I release the shop, its administrators, practitioners, stakeholders and workers from any and all of the claims, expenses, liabilities and damages.All questions about the body piercing procedure have been answered to my satisfaction, and I have been given aftercare instructions for the body piercing I am about to receive.I understand that body piercing can result in nerve damage, bone and tooth loss, and that if I choose to remove my jewelry, permanent holes or scars may be left.I am the person on the legal ID presented as proof that I am at least 18 years of age, or the bodypiercing will be performed in the presence of my parent or legal guardian.I understand there is a possibility of an allergic reaction to the jewelry inserted into the fresh bodypiercing.I understand that there is a chance I might feel lightheaded or dizzy during or after being pierced. I agree to immediately notify the body piercer in the event I feel lightheaded, dizzy and/or faint before,during or after the procedureI understand that for persons under 18 years of age: government issued photo ID will be required for both minor and consenting guardian. Birth certificate also required for minor.
Client Information
Client Name

First NameLast Name
Date of Birth

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Phone Number
Please enter a valid phone number.
Email
example@example.com
Please select the conditions you have:

AnxietyEczemaEpilepsyHemophilia/Bleeding DisordersHeart ConditionHIVInk AllergyLatex AllergyMetal AllergyPregnancyTuberculosisHepatitisHerpesScarring/KeloidingMRSA/Staph InfectionsTake Blood ThinnersFainting/DizzinessTake ImmunosuppressantsOther
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Piercing Consent Form

Client Information