Piercings By Rhi

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Let us do this part

Today's Date:

Fri May 2 2025 03:48

Practitioner:*

What Piercing are you getting?:*

Thanks for picking Piercings By Rhi!

Please read and answer

Location*

This appointment will be taking place at Studio 53, 53 Titchfield Street, Kilmarnock, KA1 1QS. The white shop next to Titch Coffee. Any issues finding us, just give me a text 07578812421

How did you hear about us?*

Under 16 years old*

Is the person getting pierced UNDER the age of 16 years old?

If YES

- Attach a clear image of the youngsters FULL BIRTH CERTIFICATE (full birth certificate does NEED to have parents names on it, if it is the abbreviated we CANNOT accept it)
If ID is not correct, your appointment will be cancelled and the deposit wont be refunded.

Eaten*

Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.

Fainting*

Are you prone to fainting attacks? If yes please make sure you bring either a full fat drink or chocolate with you.

Bloodbourne Pathogens*

Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses, such as Hepatitis, B/C or HIV?

Leave a note if any of these affect you.

Details:

Medical Conditions*

I can confirm that I do not have diabetes, epilepsy, hemophilia, nor do I have a heart condition or take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure or healing of the piercing.

Leave a note if any of these affect you.

Details:

Under the Influence *

I confirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a piercing without duress.

Permanent change*

I acknowledge that the piercing will result in a permanent change to my appearance and that my skin may not be restored to its pre-piercing condition even after its removal.

Photography*

I release all rights to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form.

Aftercare*

I confirm that I will receive an email containing my aftercare directions after finishing this form. If I do have any issues I will come to Rhi first.

Pregnant*

I am not pregnant or nursing

This Document*

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract.

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:*

Sign above or type signature:

Photo ID*

Please take photo(s) of your government issued photo IDs and related paperwork.