⇠
Body Piercing Consent and Waiver Form
Let us do this part
Today's Date:
Sat Jul 4 2026 10:49
Practitioner:*
Type of piercing/s you're having today? :*
Body Piercing Consent and release form.
Please read and answer
 
Y
N
Have you been pierced before?
Y
N
Do you have a pacemaker fitted? If yes, whilst not a reason to not get pierced, are you still happy to continue and acknowledge associated risks above?
Y
N
Do you have Epilepsy
Y
N
Do you suffer from high/low blood pressure?
Y
N
Do have Haemophilia? If so, please gain consent from your GP. You may be discouraged from getting a piercing due to the associated medical risks, such as infection.
Y
N
Are you Diabetic? Please be aware of the risks involved with piercing and being Diabetic. Piercings can take longer to heal and may cause infection due to this.
Y
N
Are you currently having/had Radiotherapy?
Radiation can destroy the cells ability to heal so please be aware your piercing may not heal correctly. If radiotherapy occurred in one specific area, we can use an alternative side,
Y
N
Are you currently pregnant or breastfeeding?
Y
N
Are you currently on blood thinners?
Y
N
Do you have any allergies or skin conditions?
If yes, please add details below.
(The jewellery we use is implant grade Titanium. Therefore it contains no nickel)

Details: 
Y
N
Have you had recent operations? If yes, please state below.

Details: 
Y
N
Do you have any transmittable diseases or recent illnesses? H.I.V, A.I.DS, Hepatitis?
(It's okay if you do, we just want to know for our and other's safety).

Details: 
I affirm that I do not have diabetes, epilepsy, hemophilia, nor do I have a heart condition or take blood thinning medication. 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. I am not pregnant or nursing.
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.
Y
N
IF YOU HAVE:
- a fever
- flu-like symptoms
- shortness of breath

YOU NEED TO NOTIFY A STAFF MEMBER IMMEDIATELY.
Y
N
Have you eaten in the past 4 hours? It's a good idea to beforehand to increase your blood sugar levels.
TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist 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.
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.
I affirm that I have been given instructions on the care of my piercing while it’s healing. I understand them and will follow them. I acknowledge that I have been pierced in a sterile environment and the aftercare is my responsibility. It is possible that the piercing can become infected, particularly if I do not follow the instructions.
I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a piercing without duress.
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 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.
I am happy for photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form via website and social media pages.
(You’re more than welcome to say no)
Thank you for choosing Nova Body Piercing.
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 18 your parent/guardian will be required
Age: 
Phone #:*
Email:*
Signature:*

Emergency Contact
If something happens, your emergency contact might need to explain your medical history, allergies, or medications.
Name:
Phone #:*
Photo Identification
Please take photo(s) of your government issued photo IDs and related paperwork