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Body Piercing
Let us do this part
Today's Date:
Mon Sep 22 2025 08:53
Practitioner:*
Piercing(s):*
PIERCING CONSENT FORM – PLEASE READ CAREFULLY
To be completed within 24 hours of your appointment (ideally 1 hour before).
If you are filling this out on behalf of someone under 16, please use their details and upload a photo of both your ID and theirs.

If you have any questions about the form or your appointment, please get in touch via piercingsbysophie@outlook.com
Please read and answer
Y
N
ILLNESS & SYMPTOMS*
Do you currently have any flu-like symptoms?
If you are experiencing any of the following, please let a staff member know as soon as possible, and be aware that your appointment may need to be rescheduled:
• Fever
• Chills or flu-like symptoms
• Shortness of breath or persistent cough
Y
N
FOOD & BLOOD SUGAR*
Have you eaten in the last 4 hours?
It’s important to eat before your appointment to help keep your blood sugar stable and avoid dizziness or fainting. A small meal or snack is recommended.
Y
N
BLOODBORNE PATHOGENS & COMMUNICABLE CONDITIONS*
Do you have any bloodborne pathogens, transmittable diseases, or recent illnesses?
(This includes conditions such as hepatitis B/C, HIV, or any recent infections.)

Answering yes does not exclude you from being pierced – it simply helps us maintain safe hygiene practices for everyone.
Details:
 
Y
N
MEDICAL CONDITIONS*
Do you have any of the following medical conditions or concerns?

Please confirm that none of the following apply to you, or let us know if they do so we can discuss any necessary precautions:
• Diabetes
• Epilepsy
• Haemophilia or bleeding/clotting disorders
• Heart conditions
• Blood thinning medication (e.g. aspirin, warfarin)
• Skin conditions that could affect healing (e.g. eczema, psoriasis at the piercing site)
• Organ or bone marrow transplant recipient (if so, confirm that prescribed preventative antibiotics have been taken)
• Pregnancy or breastfeeding

Please contact me before your appointment if any of these apply: piercingsbysophie@outlook.com
Details:
 
RISKS*
I confirm that I am fully informed of the risks associated with getting a piercing. These risks may include, but are not limited to:
• Swelling, bruising, or bleeding
• Infection
• Allergic reaction to materials used
• Scarring or keloid formation
• Rejection or migration of jewellery

I understand that while these risks are uncommon, they are possible. I accept full responsibility for my decision to be pierced and acknowledge that results may vary based on individual healing and aftercare.

If you have any questions, please contact me: piercingsbysophie@outlook.com
AFTERCARE*
I understand that full aftercare instructions will be explained to me during my appointment, and I will have the opportunity to ask any questions at that time.
I also acknowledge that I have access to an online aftercare sheet which I can review in advance here:
https://postimg.cc/bG3W0ZWX

I understand that failure to follow aftercare advice can result in infection, prolonged healing, or other complications. I agree to follow the guidance provided as closely as possible.
RELEASE OF LIABILITY*
To the fullest extent permitted by UK law, I agree to waive and release the piercer and the studio from any liability for injury, reaction, infection, or any other complication that may occur during or after the piercing procedure. This includes both direct and indirect consequences, whether caused by negligence or otherwise.
QUESTIONS*
I understand that I will have the opportunity to ask any and all questions about the procedure during my appointment, and that the piercer will be happy to explain anything I’m unsure about.
If I have any questions or concerns before the appointment, I can also contact the piercer in advance at piercingsbysophie@outlook.com.
VOLUNTARY CONSENT*
I confirm that I am not under the influence of alcohol or drugs, and that I am voluntarily choosing to have this piercing without pressure or coercion.
MEDICAL DISCLOSURE*
I confirm that the medical information I have provided in this form is accurate and complete to the best of my knowledge. I understand that withholding relevant information may affect the safety or outcome of the procedure.
PERMANENT CHANGE*
I acknowledge that getting a piercing is a permanent change to my body. I understand that even if I choose to remove the jewellery in the future, the piercing site may not return to its original appearance, and some scarring or marking may remain.
THIS DOCUMENT*
I confirm that I have read and understood this document, and that I am signing it with adequate time to consider the information provided. I understand that this is a legally binding consent form.
Y
N
PHOTOGRAPHY*
I give permission for photographs of my piercing to be taken and used by the piercer or studio for promotional or educational purposes (such as social media or website use). If I prefer not to be photographed or wish to keep images private, I will inform the piercer during my appointment.
 
HOW DID YOU HEAR ABOUT US?
 
The information provided below is for the person receiving the piercing. If you are completing this form on behalf of a minor, you will have the opportunity to fill out a separate section for parental consent afterwards.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
Legal Name:*
Pronoun:
Chosen name:
Address:*
Postcode:*
Date of birth:*
If you are under 16 your parent/guardian will be required
Phone #:*
Email:*
Signature:*


Parent/Legal Guardian
I, as custodial parent or legal guardian of the above minor under 16 years of age, hereby consent to the terms and conditions set forth in this release form and I attest that all documentation I have provided is true and accurate.
Parental Consent for Under 16's
Guardian's Legal Name:*
Relationship:*
Signature:*


Emergency Contact
If something happens, your emergency contact might need to explain your medical history, allergies, or medications.
Name:
Phone #:
Photo ID*
Please take photo(s) of your government issued photo IDs and related paperwork.
Please be sure to include a clear photo of your Photo ID, it must include your date of birth. If you are filling out the form for a minor, please include both of your IDs.