Piercing Consent

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Let us do this part

Today's Date:

Fri Apr 19 2024 05:53

Practitioner:*

Exact Body Piercing on Body/Ear:*

Piercing Value::*

Jewellery Value::*

Deposit Paid::*

Final Total::*

Please read and answer

Diabetes Type 1: - (Low/ No Insulin/High Blood Sugars) / Diabetes Type 2: (Insulin Resistance / Low Blood Sugars)*

If you are type diabetic, it is important to make sure that your blood sugar levels have been well controlled pre and post piercing as this will help your piercing to heal.
If your blood sugar levels are too high, too low, or otherwise inconsistent, then piercing can carry additional healing risk due to poor circulation.

People with Diabetes are reported to be five times more susceptible to bacterial and fungal infections at wound sites.
Delayed healing is common even in non-infected wounds, and as such we expect a longer healing time for most diabetic patients.

To reduce post-piercing complications it is crucial to follow aftercare advice, and consult with your GP and Piercer should concern arise.

Details:

Pregnancy*

Are you pregnant, or nursing?

Medication

Are you currently taking any anti-biotics to treat or as as a preventative method for infection? (Including treatment for acne).

If you have been on a course of anti-biotics / are currently on anti-biotics - please inform the piercer before continuing with your consent form.

Medication Details*

Please detail any medication you require or are currently taking, and you confirm it is on your person.

Details:

Medical Conditions*

Please confirm:

- You do not have any other medical or skin condition that may interfere with the procedure or healing of the piercing.

- You are not the recipient of an organ or bone marrow transplant, or, if you are, you have taken the prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such as piercing.

If you do have any of the above conditions, please give details below.

Details:

Alcohol/Drugs*

Please confirm that you are not, or have not been under the influence of alcohol or drugs in the past 24 hours.

Eaten*

Have you eaten a substantial meal or snack today?

Risks*

You confirm that you have been fully informed of the risks associated with getting a piercing, and are still happy to proceed.
You are voluntarily getting a piercing without duress/pressure.
You understand that a piercing will create a permanent change to my appearance and that my skin may not be restored to its pre-piercing condition even after its removal.

I understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring and keloiding, and allergic reactions. While your piercer takes every care to keep you informed, it is your responsibility to follow the correct aftercare, and report back immediately if any issues arise.

Release Liability *

You agree to waive and release (to the fullest extent permitted by law) the liability of both the Artist and the Piercing Studio from any issues which result or arise during or post-piercing, whether caused by the negligence or fault of either the Artist or the Piercing Studio.

You understand that piercing is a precision based but inexact science, and on rare occasions, the results may require an angle adjustment or re-pierce regardless of the skill level of my practitioner.

Aftercare*

I confirm that I have been given full instructions for the aftercare of my piercing. (You will be given a physical copy to take away with you, and will also have access to a digital copy e-mailed to you attached to your own copy of this consent form) and access to a trouble-shooting guide via the website should this be lost.

Photography*

You 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, most commonly social media.

Jewellery Downsizing*

You confirm that you are aware of the importance of downsizing your jewellery once the swelling has dissipated.

Keeping the initial piercing jewellery in for longer than the advised time can increase the risks of a longer period of healing, rejection, migration, and excess scarring.

I understand that each piercing downsize incurs an additional fee of £15.00 (per stem) to cover the cost of the jewellery.

Jewellery Loss Policy*

You understand that it is your sole responsibility to regularly check that your jewellery is on secure, and we are not liable for any losses that may occur.

Our Brand Guarantee covers manufacturers defect only and excludes mishandling and accidental damage or loss.

The brands covered by our guarantee include:
NeoMetal
Junipurr
Anatometal
Industrial Strength
Body Gems
Inari Organics
BVLA
Buddha Jewellery Organics

Tish Lyon Jewellery carries a 1 Year Warrenty only.

Aftercare Pamphlet *

I confirm I will check my e-mail for the provided aftercare information. This will be connected to your consent form. Please check your junk mail.

Absolute confirmation*

Having been informed of the potential risks associated with getting a piercing, and having read the information within this consent form in full, you still wish to proceed with absolute certainty with my piercing.

You confirm 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 and am still wishing to go ahead with the procedure.

You understand that you are signing a legal contract.

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:

Address:*

Postcode:*

Date of birth:*

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

Phone #:*

Email:*

Social Handle:

If you don't mind us tagging you in photos online

Signature:*

Sign above or type signature:

Parent/Legal Guardian

I, as custodial parent or legal guardian of the above minor under 16 years of age, hereby consent to the terms and conditions set forth in this release form and I attest that all documentation I have provided is true and accurate.

Guardian's Legal Name:*

Relationship:*

Signature:*

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:

Photo ID*

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