Permanent Jewelry Consent Form

Permanent Jewelry Consent Form

Please fill out this form to give your consent for permanent jewelry.
Client Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Understanding of Risks and Procedure:

I acknowledge that I have discussed the procedure at Saguaro Spark. I understand that the procedure may involve:
- Long-term care and maintenance requirements for the jewelry.
I have been provided with aftercare instructions, and I understand the importance of following them to minimize complications.

Consent and Release:

I voluntarily and willingly consent to the permanent jewelry procedure and assume any risks associated with it. I release Saguaro Spark, its practitioners, employees, and affiliates from any liability for complications, injuries, or damages resulting from the procedure.

Age Verification:

I confirm that I am at least 18 years of age, or if I am a minor, I have obtained the consent of my parent or legal guardian for this procedure.

Photo Release:

I give permission for photographs or images of the procedure and the jewelry placement to be taken for documentation and educational purposes.

Signature:

I have read and understood this Permanent Jewelry Consent Form, and I sign it of my own free will.
Date

MonthDayYear
Date
Signature

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Permanent Jewelry Consent Form

Client Information