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Piercing consent form
Piercing consent form
I voluntarily give my full consent to body piercings carried out by the practitioner. I am informed about possible side effects and complications of 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.
Please acknowledge the following items:
(Required)
I do not have symptoms of COVID-19 and accept to follow the rules of the shop during my appointment.
I have not contacted to anyone who may have symptoms of COVID-19 or get infected by the virus within 14 days.
I understand that I am responsible for the any touch-up work due to my fault, negligence or carelessness.
I understand that there is a possibility to get an infection if I will not follow the instructions.
I accept that having a piercing services is my voluntary choice.
I inform that I am not under the influence of drugs or alcohol.
I understand that the procedure causes a permanent change to my skin and body.
I do not have any mental or medical disability that may affect my wellbeing as a result of having piercing procedure.
I release the shop, its administrators, practitioners, stakeholders and workers from any and all of the claims, expenses, liabilities and damages.
Client Information
Client Name
First Name
(Required)
Last Name
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Phone Number
(Required)
Email
(Required)
Please select the conditions you have:
Anxiety
Epilepsy
Heart Condition
Ink Allergy
Nickel Allergy
Tuberculosis
Eczama
Haemophilia
HIV
Latex Allergy
Pregnancy
Other
Appointment
Date
(Required)
MM slash DD slash YYYY
Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Signature
(Required)
Signed Date
(Required)
MM slash DD slash YYYY
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