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Louisville Body Piercing
Let us do this part
Today's Date:
Tue Jun 9 2026 02:49
Practitioner:*
Body Piercing Location:*
Jewelry Used:*
Body Piercing Price:*
Tattoo Charlie's Louisville Piercing Consent Form
Photo Identification *
Please take photo(s) of your government issued photo IDs and related paperwork
Please read and answer
Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.
I acknowledge I am not pregnant.
I attest to the fact that I am not intoxicated or under the influence of drugs or alcohol.
That I have been fully informed of the risks, associated with getting a piercing. I understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring and keloiding, and allergic reactions. Having been informed of the potential risks associated with getting a piercing, I still wish to proceed with the piercing and I freely accept all risks that may arise from the piercing.
TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise, whether caused by the negligence or fault of either the Artist or the Studio, or otherwise.
That both the Artist and the Studio have given me the full opportunity to ask any and all questions about the tattoo procedure and the they have been answered to my total satisfaction.
Aftercare Instructions

#1 RULE : DO NOT TOUCH

DO NOT twist, turn, rotate, or play with your jewelry!

AVOID UNDUE TRAUMA such as hitting, bumping, snagging, or direct pressure as this can cause complications through the healing process.

CLEANING SOLUTIONS

DO NOT clean your piercing with soap, Bactine, rubbing alcohol, hydrogen peroxide, antibiotic ointment, hibiclens, Betadine, BZK, or other Ear Care Solutions. Also avoid getting lotion, perfume, makeup, or other personal care products in or near your piercing.

SALINE sprays are great for irrigating the piercing throughout the day.

ORAL PIERCING SUGGESTIONS :

AVOID smoking and AVOID drinking through straws as these can cause additional swelling.

AVOID using mouth rinse containing alcohol.

BIOTENE Oral Care mouth rinse is suggested.

BUY A NEW TOOTHBRUSH!

If you see any signs or symptoms of infection such as
fever, excessive swelling, excessive redness, or drainage, you are instructed to consult a physician.
I affirm that I have been given instructions on the care of my piercing and that I understand them and will follow them. I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions.
I acknowledge that the piercing will result in a permanent change to my appearance.
According to health department requirements, I have not taken a blood thinner within the last 24 hours.
I understand that body jewelry is made up of moving parts and there is a possibility it can come apart and become lost. We at Tattoo Charlie's will make every effort to secure all threaded tops and threadless ends to guard against that happening. Fidgeting with your jewelry or snagging it on clothing/bedding/hair can increase the chance of jewelry coming apart. Tattoo Charlie's is not responsible for lost jewelry.
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In the case where I give consent to my piercing being photographed, 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.
Privacy Statement

We will not use your contact information (other than email) for any purpose other than records keeping as required by the Kentucky Department of Health Services. It will not be sold to any third party.
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:*
Chosen name:
Address:*
Postcode:
Date of birth:*
 
If you are under 18 your parent/guardian will be required
Age: 
Phone #:*
Email:
Signature:*