Piercing Consent Form

I acknowledge by filling out this release, that I have been given my full opportunity to ask any and all questions that I might have about obtaining a piercing and all my questions have been answered to my complete understanding and satisfaction.

Client Information

First name

Last name

Age

Birth Date

Month

Day

Year

Phone Number

Email

Instagram Account

Date and Time of Visit

Pre-Procedure Questionnaire

I do not suffer from any medical or skin condition/s such as, but not limited to: keloid/s, hypertrophic scarring, psoriasis, or any open wound/s or lesion/s on the site of the piercing.

Yes

No

To my knowledge, I do not have any physical, mental, or medical impairment or disability that might affect my well-being, as a direct or indirect result of my decision to have a piercing done at this time.

Yes

No

I have advised the piercer of any allergies to metals, latex gloves, soap/s and medications. I acknowledge it is not possible for the piercer to determine whether I might have an allergic reaction to the piercing or processes involved in the process.

Yes

No

Getting this piercing is my choice alone and will possibly result in a permanent change to my appearance and that there is a possibility to later restore the skin & tissue involved in the piercing.

Yes

No

If I have any condition/s that might affect the healing of the piercing/s, I will inform my piercer before the session starts.

Yes

No

I understand that piercings are subject to irritation, possible rejection, migration and other problems that need possible troubleshooting.

Yes

No

I acknowledge that infection is always possible because of getting a piercing.

Yes

No

I will inform my piercer whenever there are concerns with the piercing.

Yes

No

Acknowledgement & Waiver

I understand that this procedure is a permanent change to my skin and body.

I understand that there is a possibility to get an infection if I will not follow the aftercare instructions given to me by my piercer.

I accept that getting the piercing is my voluntary choice.

I release the Crimson River Tattoo, its administrators, practitioners, stakeholders and workers from any and all of the claims, expenses, liabilities and damages.

I confirm that the information I provided in this document is accurate and true.

Client ID

I declare that the info I’ve provided is accurate and complete.

Signature

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