Jewellery Downsize/Change/Removal Consent and Release

Let us do this part

Today's Date:

Sat Jul 4 2026 10:52

Practitioner:*

Jewellery Change/Downsize/Removal Consent and Release Form

Please read and answer

How did you hear about us?

What procedure are we doing today?*

Please list whether we are downsizing, changing jewellery or removing jewellery and what piercings they are.
E.g downsizing lobe piercings and jewellery change on helix

Did Nova Body Piercing perform the original piercing?*

Details:

Photography*

Will you allow your piercing(s) to be photographed and placed in my portfolio and/or used on social media? Photos are up close and anonymous.

If yes is selected, you release all rights to any photographs taken of your piercing(s) and give consent in advance of their reproduction in print or electronic form.

Bloodborne Pathogens*

Do you have any bloodborne pathogens, transmittable diseases or recent illnesses?
(It’s okay if you do, we just want to know for everyone’s safety)

Details:

Do you have flu-like symptoms?*

Please notify me if you do.

Release*

TO WAIVE AND RELEASE to the fullest extent permitted by law Nova Body Piercing and all artists associated from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise after I have left the studio. I understand the procedure has been performed in sterile conditions and physical aftercare is my responsibility.

Questions*

I acknowledge that both the artist and studio have given me the full opportunity to ask any questions about the jewellery change/removal procedure and they have been answered to my total satisfaction.

(The artist will always be available to answer any questions after the procedure via social media/in person)

This Document*

I acknowledge that I have been given adequate opportunity to read and understand this document, that was presented to me prior to my appointment and I understand I am signing a legal contract.

Allergies*

Do you have any allergies? If so, please give details:

Details:

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:*

Sign or type 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