Body Piercing

Let us do this part

Today's Date:

Wed Mar 25 2026 10:04

Practitioner:*

Body Piercing name:*

Please read and answer

How did you hear about us?

Eaten*

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

Allergies*

Do you have any known allergies e.g allergies to metals, latex, chlorhexidine,
(It' okay if you do, we just want to know for your and other's safety).

Details:

Bloodbourne Pathogens*

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

Details:

Medical Conditions*

Do you have any medical conditions e.g. diabetes, epilepsy, haemophilia, a heart condition or take blood thinning medication. Do you have any other medical or skin condition that may interfere with the procedure or healing of the piercing.

Details:

Pregnant or Nursing *

Are you pregnant or currently breast feeding?

Fainting or Dizziness*

Are you prone to Fainting / Dizziness?

Photography*

I give consent to photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form or piercers portfolio / social media

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.

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.

Aftercare*

I affirm that I have given me instructions on the care of my piercing while it.s healing, and 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.

Questions*

That both the Artist 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.

Duress*

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

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.

GDPR*

I have read and understood the Stabpad privacy policy for completing this form, found on the following link: hhtps://www.stapbad.com/privacy

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:*

Pronouns:

Chosen name:

Address:

Postcode:

Date of birth:*

If you are under 16 your parent/guardian will be required

Age:

Phone #:*

Email:*

Signature:*

Sign or type signature:

Photo Identification *

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