PIERCING CLIENT DISCLOSURE FORM

 Department of Professional and Occupational RegulationDPTOR Richmond, Virginia 23233-1485 Department of Professional and Occupational Regulation (804)367-8509

www.dpor.virginia.gov  

barbercosmo@dpor.virginia.gov

No person shall perform body piercing on a person less than eighteen years of age, knowing or having reason to believe such person is less than eighteen years of age except (i) in the presence of the person's parent or guardian OR (ii) when performed by or under the supervision of a medical doctor, registered nurse or other medical services personnel licensed pursuant to Title 54.1 when performing their duties.

In addition, no person shall perform body piercing on any client unless he complies with the Centers for Disease Control and Prevention's guidelines for "Universal Blood and Body Fluid Precautions" and provides the client with the following disclosure:

1. Body piercing is an invasive procedure in which the skin is penetrated by a foreign object.

2. If proper sterilization and antiseptic procedures are not followed by the body piercers, there is a risk of transmission of blood borne pathogens and other infections, including, but not limited to, human immunodeficiency viruses (HIV) as well as Hepatitis B and C viruses.

3. Body piercing may cause allergic reactions in persons sensitive to the metals used.

4. Body piercing may involve discomfort or pain for which appropriate anesthesia cannot be legally made available by the person performing the body piercing unless such person holds the appropriate license from a Virginia health regulatory board.

Listed below are some of the possible risks and dangers associated with receiving a body-piercing:

1. The possibility of discomfort or pain

2. The possibility of scarring

3. The possibility of bleeding

4. The possibility of swelling

5. The risk of infection

6. The possibility of nerve damage

7. The increased risk for adolescents during certain stages of development

NOTE: The Commonwealth of Virginia makes no endorsement of the safety of the practice of body-piercing.

By signing below, I acknowledge that:

1. I have read the information shown above.

2. I have been verbally informed by the practitioner providing the service of the risks and dangers associated with receiving a body piercing.

3. I have been given the opportunity to have a third party present while receiving body piercing services.

Virginia Board for Barbers and Cosmetology/BODY-PIERCING CLIENT DISCLOSURE FORM Page 1 of 1