Mobile Piercing by Sophie Consent Form

I voluntarily give my full consent to Mobile Piercings by Sophie. I am informed about possible side effects and complications of ear & 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.

Name*

First NameLast Name

Date of Birth*

Date

Age at time of piercing*

Email*

example@example.com

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

City

Post Code

Is there free parking within short walking distance?

Please upload a photo of photographic ID as proof of age of the client (passport or similar ID card)*

Name of parent/legal guardian (only if the client is under 18)

First NameLast Name

Relationship to client

(ONLY IF THE CLIENT IS UNDER 18)Please upload proof of parental responsibility to the child. i'e Birth certificate. Must attend the appointment also.

Do you have any other medical conditions which may effect the health of your piercing?

Are you currently taking any medications that may affect blood clotting, healing, or immune response (e.g. blood thinners, isotretinoin immunosuppressants, or antibiotics)

Are you Pregnant or have you had a baby within the last 3 months?

Have you had surgery in the past 3 months?

Do you currently have any kind of contagious medical conditions?

Do you have preferred pronouns

YesNo

What piercing are you having?

I understand I am responsible for adhering to the aftercare advice given to me at the appointment and there is a possibility of infection if I do not follow the instructionsI understand that a piercing is a cosmetic change to my bodyI confirm that I will not be under the influence of alcohol or drugsI understand that I will be shown the proposed placement of my piercing during the appointment so that it can be agreed before the piercing beginsI understand that refunds are not possible should I later be unhappy with the placement I have chosen. Should the piercer make a technical error in placement, I will be entitled to a free correction. This must be raised on the day of the piercing(s).I understand that I am responsible for the ongoing maintenance of my jewellery such as checking that fittings are tightened & downsizing in accordance with the aftercare advice to maintain a healthy piercingI accept that any issues arising from failure to communicate relevant information or failure to adhere to aftercare instructions will not be the fault of the piercerI confirm that I have disclosed any medications I am currently taking that may affect blood clotting, healing, or immune response (e.g., blood thinners, immunosuppressants, or antibiotics). I understand that certain medications may increase the risk of complications during or after the piercing procedure, and I take full responsibility for informing the piercer of any such medicationsI understand that I will be charged the full cost of my appointment if I change my mind after the process has begun

Signature of the Client*

Signature of parent/legal guardian (only if the client is under 16)

Date Signed*

Date

Mobile Piercing by Sophie Consent Form

Client Information

Consent and Waiver