Waive* I hereby give consent to my piercer at Honey Ink to perform my chosen
- Piercing (insertion)
- Removal
- Stretch
- and /or Assessment
And in consideration of its doing so, I hereby release the studio, and its employees and agents, from all amber of liabilities, claims, actions and demands, in law or in equity, which I or my heirs have or might have now or hereafter by reason of complying with my request to have jewellery inserted/removed or to have my piercing assessed or stretched.

I FULLY UNDERSTAND that any employee or agent of the studio when performing a jewellery insertion, removal, assessment or stretching does not act in the capacity of a medical professional. The suggestions made by any employee or agent of the studio are just suggestions. They are not to be construed or substituted for advice from a medical professional.

I UNDERSTAND MY JEWELLERY WILL BE INSERTED OR REMOVED using appropriate instruments and techniques. I willingly submit to these procedures, with a full understanding of possible complications such as, but not limited to, infection, allergic reaction or rejection of the piercing.

I UNDERSTAND MY PIERCING WILL BE STRETCHED only one size at a time (no more than one gauge or a few millimeters at a time) using no flare or single flare jewellery only (double flare not allowed).

I HAVE RECEIVED A COPY OF THE WRITTEN PIERCING AFTERCARE INSTRUCTIONS (You will receive this after the piercing is done, from your piercer), which I have read and fully understand and hereby assume full responsibility for aftercare and cleanliness. I understand that by having this piercing performed that I am making a permanent change to my body and no claims have been made regarding the ability to undo the changes made.

I am 18 years of age or older.
(Parental Consent/Signature Required for UNDER 16S)

Health/Medical Procedure * (Y)Yes I do have,
(N)No, I do not have,

- History of Keloid or Hypertrophic Scarring
- Diabetes
- Epilepsy
- Hemophilia
- Heart condition, nor do I take blood thinning medication.
I do not have any other condition that may interfere with the application or healing of the piercing.
- I have not had any major/minor surgical procedures and/or treatments in the last 6-12 months or currently on medications from a past procedure/treatment
- I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the preventive antibiotics.
- I do not have a mental impairment that may affect my judgment in getting the piercing.

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. (If you do not tick this provision, please advise your Piercer).

Numbing* Have you applied any numbing agents to the area being pierced?

If yes, please explain type used and when applied

Bleeding * Are you prone to heavy bleeding?

Bloodbourne Pathogens* Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses?

Influence* Have you had any alcoholic beverages in the last eight hours or under the influence of any drugs?

Food* Have you eaten in the past 4 hrs?

We recommend you have something to eat as It's a good idea to beforehand to increase your blood sugar levels, (Coffee and/or Energy drinks do not count as food)

Latex Allergy* Do you have a latex allergy? If yes, please let your piercer know as we generally use latex gloves.

Known Allergies* Do you have any known allergies or skin sensitivities ?
If Yes, please let your piercer know and list them all below.

(Some products we use in studio may contain Aloe Vera, Lavender, Witch Hazel, Honey, Leaf/Flower and Fruit Extracts and Oils just to name a few)

Blood Pressure * Do you have high blood pressure ?

Medication* Have you taken any forms of Medication(s) in the last 24 hours?

Including any
- Aspirin,
- Paracetamol,
- Ibuprofen,

or are on any current Antibiotics or Acne Medications?

Please list ALL current medications below.

Fainting * Are you prone to fainting? (Light headed and/or dizziness)
If yes, please let your piercer and staff know.

Pregnancy* I am not pregnant or breastfeeding. (Tick yes to say your are not)

Acknowledgement * (1) I acknowledge that the sterilisation method used was explained to my full satisfaction.
(2) I had the opportunity to ask questions regarding this procedure.
(3) All questions were answered to my satisfaction.
(4) All equipment during the procedure was opened in front of me.
(5) I witnessed the disposal of the piercing needle(s) into regulated sharps containers.
(6) Both written and verbal Piercing Aftercare Instructions were provided to me.
(7) I have read this Insertion/Assessment/Stretch Release Form and confirm that all the information I have given is correct.
(8) I understand that this is a release form and I agree to be legally bound by it.

Emergency * In the event that the practitioner reasonably believes emergency medical assistance is required,
I authorise the practitioner and/or studio staff to contact emergency services (000) and seek appropriate medical treatment on my behalf.


I understand that any costs associated with ambulance transport, hospital treatment, medical assessment, or other healthcare services are my responsibility.

And consent to have your emergency contact contacted on your behalf?