Understanding of Risks and Procedure:
PERMANENT JEWELRY IS A PROCESS THAT INVOLVES THE USE OF
A WELDING MACHINE TO WELD THE JEWELRY TOGETHER WHILE
ON YOUR BODY. THE PROCESS IS PAINLESS AND IS PERFORMED
WITH YOUR SAFETY IN MIND. THIS CONSENT FORM IS INTENDED
TO INFORM YOU OF THE RISKS OF THE PROCESS AND OBTAIN
YOUR INFORMED CONSENT FOR THE PROCESS.
- I understand that although rare, an allergic reaction to the
jewelry can occur.
- I do not have a pacemaker. Welding with pacemakers is very
dangerous and should not be performed. Please ask the
welder for a clasp instead.
- I understand that although this jewelry is intended to be
permanent, durable, and long-lasting, the length of wear can
vary depending on my physical activity and other factors.
- I understand that the welding process does have some risks,
including but not limited to potential allergic reactions, irrita-
tion, discomfort, burns, and scarring.
- I agree to the jewelry care instructions recommended by the
technician.
- I understand that there may be some instances where I will
be required to remove my jewelry, including but not limited to
medical procedures like MRI and surgery. I understand that
the jewelry can easily be removed with scissors and re-at-
tached by the welder at a later date for a welding fee.
- I give the technician/jeweler permission to photograph my
jewelry and process for their own marketing and promotional
purposes.
- I understand that if my jewelry breaks at the weld within 14
days of placement, Toadstool Permanent Jewelry will re-weld
free of charge.
- I understand Toadstool Permanent Jewelry does not offer any re-
funds as jewelry is custom fit to each specific individual.
Consent and Release:
I have read and agree to the terms of this consent form, both front and
back. I have had the opportunity to ask questions and have received satis-
factory answers. I understand the risks and potential side effects associ-
ated with the permanent jewelry process. I understand that the results of
the process are not guaranteed and may vary from person to person. I am
over the age of 18 and consent to the process. If I am under the age of 18,
a parent or guardian must sign. I will not hold the technician/jeweler, salon,
or employees liable for any issues not disclosed at the time of my service
or any adverse effects from the permanent jewelry process. This agree-
ment remains in effect for this procedure and any follow-up appointments
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.