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Tooth Gem Release Form

Let us do this part
Today's Date:
Thu May 1 2025 06:53
Practitioner:*
:
Please read and answer
Terms and Conditions*
I understand that Trilllogy Tattoo and its agents make no claims, warranties, or guarantees as to the safety of any materials including but not limited to the jewelry itself, glues or any other products used in the application of the tooth gem.
I understand that having this service is temporary.
I understand that if my Tooth Jewelry falls out for any reason except mistreatment or failure to properly follow aftercare guidelines during the two weeks following the procedure, it will be replaced at no charge. After two weeks there is no guarantee, or warranty of replacement. If I wish to have another tooth jewelry installed, I will bear the cost of the service and jewelry myself.
If my teeth or any other body part, is harmed in any way from having this service done, I myself will be responsible for any and charges that will be made to me for the repairs by a professional. (I.e. chipping, biting, etc.)
If in the event I no longer wish to have my tooth jewelry, I myself will be responsible for all charges that will be made to me by a dental professional in the removal of my tooth jewelry.
ALL services , procedures, jewelry sales and tooth gem installations are final.
No refunds and No exchanges of any kind.

I hereby release and agree to hold Trilllogy Tattoo/Piercing harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Trilllogy Tattoo/Piercing or that may otherwise arise in any way in connection with any services received from Trilllogy Tattoo/Piercing.

I understand that this release discharges Trilllogy Tattoo/Piercing from any liability or claim that I, my heirs, or any personal representatives may have against Trilllogy Tattoo/Piercing with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from TrilllogyTattoo/Piercing.

* I fully understand that Trilllogy Tattoo/Piercing does not require to see my vaccination card, and if I decide to not provide proof and any/all situations that can stem from it, I am fully liable.

*I fully understand that I, or anyone else cannot take pictures or video while the procedure is in place. If found doing so, I understand that I or anyone else will be asked to leave immediately.

This liability waiver and release extends to the establishment, together with all owners, partners, and employees.

I have read and understand all sections of this contract to its entirety.
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.
Name:*
Address:*
Postcode:*
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:*
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Signature:*


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