Birthday

Piercing Date

Piercer Name*

I am over the age of 18 and have truthfully represented my age. *

I have eaten within the last two hours.*

Have you consumed alcohol or drugs within the last 24 hours?

Is your blood pressure regular?*

Do you have a heart condition?*

D you have any conditions that compromise your immune system?*

Have you ever suffered from HIV, Hepatitis A,B or C or any blood disorder?*

Are you allergic to the penicillin family of drugs?*

Are you diabetic?*

Do you have any blood clotting disorders?*

Are you pregnant or breast feeding?*

Do you suffer with any seizure causing condition?*

Are you prone to dizziness or fainting?*

I agree that every care has been taken to ensure that this procedure has been carried out in a hygienic manner and that the aftercare of the piercing/s is my sole responsibility.*

I agree to follow the aftercare from my piercer and understand all risks associated with piercings I.E infection, allergic reactions, scarring, migration, bruising and rejection etc.*

I agree to fully check the placement of my piercing before any work commences and failure to do either of the above is not the responsibility of the piercer.*

I understand that piercing is not an exact science and the piercing process/healing experience can vary from person to person usually dependant on lifestyle.*

By completing this consultation form I give my full permission for my piercing/s to go ahead and I agree that I have provided all information truthfully.*

I understand that it is my responsibility to check the tightness of my jewellery.. If it falls out within 7 days of getting the piercing done my piercer will rectify it for me at no extra charge, after that I understand that I will be charged full price.*

I give consent for photos to be taken of my piercing for use for advertising.*

Parental Consent - I confirm I am legally responsible for the above named and give full consent for my child. (If Applicable)