Client Consultation Form

Please answer the following questions to help us understand your needs and ensure a safe and successful permanent jewelry placement procedure.

By signing below, I confirm that I have answered the questions to the best of my knowledge, and I understand that this consultation form helps assess my suitability for permanent jewelry placement.

I,                               ,hereby consent to the service of receiving permanent jewelry. I understand and acknowledge the following: Purpose: The purpose of this service is to permanently affix jewelry to my body, typically on areas such as the wrist, neck, ankle, or other agreed-upon locations.

Risks and Complications: I understand that there are potential risks and complications associated with permanent jewelry, including but not limited to skin irritation, allergic reactions, minor discomfort during placement, jewelry displacement or breakage, and the possibility of requiring removal. Aftercare: I understand that proper aftercare is essential to maintain the integrity of my permanent jewelry. I agree to follow the provided aftercare instructions carefully and seek medical attention if any complications, such as irritation or allergic reactions, occur. Maintenance: I acknowledge that proper maintenance, including regular cleaning and checking the security of my jewelry, is necessary. I understand that neglecting maintenance may increase the risk of complications and reduce the longevity of my permanent jewelry. Personal Responsibility: I take full responsibility for the jewelry after it is placed, including any potential damage, loss, or theft. I understand that the studio or practitioner will not be liable for any such incidents. Consent to Procedure: I consent to the permanent jewelry placement procedure and acknowledge that the practitioner has explained the procedure, risks, and aftercare instructions to me. I have had the opportunity to ask questions and have received satisfactory answers. Financial Responsibility: I understand that there is a fee associated with the permanent jewelry placement procedure, which has been discussed and agreed upon prior to the

By signing below, I confirm that I have read and understood the information provided in this consent form, and I voluntarily give my informed consent for the permanent jewelry placement service.

I,                           ,hereby grant permission to Luxiries Archive to capture and use photographs and/or videos of me in relation to the permanent jewelry placement procedure. I understand and acknowledge the following:

Purpose: The purpose of capturing these photographs and/or videos is to document and showcase the process and results of the permanent jewelry placement service.

Use of Media: I grant permission for the organization or individual to use the photographs and/or videos in various promotional and educational materials, including but not limited to websites, social media platforms, printed materials, and presentations.

Confidentiality: I understand that my personal information will be kept confidential and that the photographs and/or videos will be used solely for the purposes stated above.

No Compensation: I acknowledge that I will not receive any financial compensation for the use of these photographs and/or videos.

Ownership: I understand and agree that the organization or individual capturing the photographs and/or videos shall retain all ownership rights to the media.

Release of Liability: I release the organization or individual, its representatives, employees, or any other parties involved, from any claims or liabilities arising from the use of the photographs and/or videos, including but not limited to any claims for defamation or invasion of privacy.

By signing below, I confirm that I have read and understood the information provided in this photo and video release form, and I voluntarily give my informed consent for the organization or individual to capture and use photographs and/or videos of me during the permanent jewelry placement procedure.