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Body Piercing Form

Let us do this part

Today's Date:

Thu Jul 31 2025 04:05

Practitioner:*

Name of the piercing (piercing location). :*

Body Piercing Jewelry (ASK PIERCER FOR CODE):*

Iron Forged Body Works (8147 Pat Booker Rd., 78233) Piercing Client Form and Release Form

Please read and answer

Eaten*

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

Bloodbourne Pathogens*

Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses? (It' okay if you do, we just want to know for our and other's safety).

Risks*

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 piercing.

Release*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Piercer and the Piercing 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 Piercing Studio, or otherwise.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 waving certain right to recover against the piercer and the studio.

Questions*

That both the Piercer and the Piercing Studio have given me the full opportunity to ask any and all questions about the piercing procedure and the they have been answered to my total satisfaction.

Aftercare*

I affirm that I have been given instructions on the care of my piercing(s). I do understand them and I will follow them. I acknowledge that it is possibility that the piercing may become infected, particularly if I do not follow the instructions. If any issues arise, I will contact the piercer and/or the shop with any questions or concerns.

Duress*

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

Medical Conditions*

I do not have any other medical or skin condition that may interfere with the procedure or healing of the piercing. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such as piercing.

Permanent*

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.

I am NOT pregnant.*

I am not pregnant.

Do you have a valid state issued ID/DL?*

Under 18 years old: Did you provide us with the proper Identification? if so, then you may get pieced. If you are over 18 and your ID or DL is expired, please come back when you have updated your ID or DL.

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.

Piercings/Jewelry check up

Can we check up on your piercing if needed? We would contact through our business phone lines or email.

How did you hear about us?

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:

Date of birth:*

If you are under 18 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.