Medical Questionnaire

Medical Questionnaire
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Medical Questionnaire

The following medical questions are confidential, and solely used by the staff at Laughing Buddha Body Piercing to ensure the procedure is being performed safely.
Have you taken any alcohol or narcotics today?

YesNo
Are you pregnant or breastfeeding?

YesNo
Do you have any illness which weakens the immune system?

YesNo
Do you have a history of herpes at procedure site or diabetes?

YesNo
Do you have a history of medication use, or are you currently using any medication (including antibiotics)?

YesNo
Do you have any condition, or take any medication which thins the blood (e.g. high blood pressure, hemophilia)?

YesNo
Are you vegan or vegetarian?

YesNo
Are you prone to excessive bleeding?

YesNo
Are you prone to excessive scarring?

YesNo
Do you have any metal, latex, iodine or soap allergies?

YesNo
Have you had this exact piercing done before (i.e. is this a re-piercing)?

YesNo
Do you have a fever, cough, body aches, shortness of breath?

YesNo
Have you eaten within the last 3 hours?

YesNo
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