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Follow up (PBR)

Let us do this part
Today's Date:
Sun Jul 13 2025 05:27
Practitioner:*
Cycle number:*
Notes:*
Follow up appointment
Please read and answer
Y
N
Check up*
I agree that the Rhian has throughly checked my piercing, that it is healing well and I'm satisfied with my check up and advice I've been given.
Y
N
Downsize*
I have received a downsize at this appointment and am happy with the outcome.
Details:
 
Y
N
Jewellery change *
I have been advised that my piercing is not ready for a downsize or to be changed to a ring. Should I choose to do this myself then I do so at my own risk.
Y
N
Jewellery change 2*
I have received a jewellery change to either a ring or another stud and front and have been advised that I may experience soreness, irritation or swelling in the first few weeks and that I will contact my piercer if I have any concerns and will not remove my jewellery until I have seen my piercer.
Details:
 
Y
N
Removal*
Rhian has removed my piercing as they feel it is not healing well. I've understood further aftercare advice and we've discussed and agreed the next steps.
Y
N
Lost jewellery*
My jewellery has fallen out and needs to be replaced with a new piece, I understand that my piercing may have closed up and if it has then I will need to wait for it to heal before getting it repierced. I accept that it is after the 3 day period of the jewellery being fitted and I am therefore responsible for the loss and will have to pay for a replacement in full.
Details:
 
Y
N
Upsize*
My piercing needs upsizing due to excessive swelling.
Y
N
Problematic piercing*
My piercing is well healed but has had a flare up. I have declared any possible risks that may made this happen for Rhian to be able to eliminate the cause
Details:
 
By filling out and signing this disclaimer you agree that you are happy with the piercers advice and notes and that if You do not follow them then you do so at my own risk.
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:*