Intricate Ink Body Piercing Consent/Wavier Form

Intricate Ink Body Piercing Client Consent/Waiver Form
Full Legal Name*
Date of Birth*
Age*
Phone Number*
Format: (000) 000-0000.
Email Address*
example@example.com
Address*

Home Address

Street Address Line 2

City State ZIPState / Province

Postal / Zip Code
Note: Clients must be at least 18 years old for body piercings unless accompanied by a legal guardian. Minors must provide valid identification and have a parent/guardian present.
ID Number*
Parent/Guardian Name if applicable
Parent/Guardian ID Number/Photo
File Upload

Cancelof
Piercing Type*
Location on Body*
Jewelry Type & Material
Medical History
DiabetesHeart ConditionHigh Blood PressureBlood Clotting DisorderEpilepsy/ SeizuresHepatitis (A,B,C)HIV/AIDSSkin Conditions (e.g. ezema, psoriasis, keloids)Autoimmune DisorderAllergies to Latex, Ink or AntisepticsNone of these aboveOther
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
If yes please explain
I, acknowledge that I have been informed of and understand the following: I am voluntarily receiving a body piercing and understand the risks involved, including but not limited to infection, allergic reactions, pain, swelling, scarring, and permanent changes to the pierced area. The piercer has explained the procedure, risks, and aftercare instructions to me in detail. I confirm that I am not under the influence of alcohol, drugs, or any medications that may impair my judgment at the time of this procedure.

WAIVER OF LIABILITY AND INFORMED CONSENT,

I understand that the piercer is not a licensed medical professional and that this procedure is not a substitute for medical treatment.

I release Intricate Ink Tattoo and its employees from all legal claims, damages, or liability related to my decision to receive a piercing. I have had the opportunity to ask questions and am satisfied with the information provided.
I acknowledge that I have received written and verbal aftercare instructions including:
- How to clean and care for my new piercing.
- Signs of infection and when to seek medical attention.
- The expected healing timeline and activities to avoid during healing.
- I understand that failing to follow aftercare instructions may result in complications. I agree to follow all instructions provided.
Client Signature*
Piercers Name Printed*
Piercers Signature*
PARENT/GUARDIAN CONSENT (FOR MINORS)
Yes, I am the Legal Guardian
ParentGuardian Signature
Should be Empty:

Intricate Ink Body Piercing Client Consent/Waiver Form

Medical History

PARENT/GUARDIAN CONSENT (FOR MINORS)