Piercing Consent Form | Aesthetics Forms Portal

Piercing Consent Form - Epic Tattoos

Client Details

Full Name: *

Date of Birth: *

Contact Number: *

Email: *

Medical History

Are you currently taking any medications? *

Please list: *

Do you have any allergies? *

Please list: *

Do any of the following apply to you? Please tick all that apply.

Do you have any other medical conditions? *

Please list: *

Have you recently been unwell? *

Which of the following were you unwell with? *

Please provide more detail: *

Emergency Contact Details

Emergency Contact Name: *

Emergency Contact Phone: *

Emergency Contact Relationship: *

Ear Piercings

Piercing Location (Ear):

If Other, Please specify:

Facial Piercings

Piercing Location (Facial):

Eyebrow Nose Septum Lip Other

If Other, Please specify:

Body Piercings

Piercing Location (Facial):

Other Belly Button

If Other, Please specify:

Possible Risks

Any type of piercing poses a risk of complications. The risks associated with getting a piercing include, but are not limited to, the following:

Allergic reactions. Some piercing jewellery — particularly pieces made of nickel — can cause allergic reactions.
Oral complications. Jewellery worn in tongue piercings can chip and crack your teeth and damage your gums. Tongue swelling after a new piercing can interfere with chewing and swallowing — and sometimes breathing.
Skin infections. This might cause redness, pain, swelling or a pus-like discharge after a piercing.
Other skin problems. Piercing can lead to scars and raised areas caused by an overgrowth of scar tissue (keloids).
Tearing or trauma. Jewellery can get caught and torn out accidentally, potentially requiring stitches or other repair.

You might need medication or other treatment if you develop an allergic reaction, infection or other skin problem near the piercing. Please seek medical advice immediately if you are worried about any of your symptoms after obtaining a piercing.

Please read the statement carefully and tick to show your agreement. *

I have been fully informed of the risks of piercing. Having been informed of the potential risks associated with getting a piercing I still wish to proceed with the piercing procedure and I assume any and all risks that may arise from piercing.

Consent

I acknowledge that I have truthfully represented to the Piercer that I am over 18 years of age. For clients under the age of 18, a parent or legal guardian's consent and presence during the procedure isrequired.

I acknowledge that that the Piercer might take pictures and videos of the tattoo I received for social media purposes.

I have advised the Piercer of any allergies to metals / latex gloves / soaps and medications. I acknowledge it is not reasonably possible for the Piercer to determine whether I might have an allergic reaction to the piercing or processes involved in the piercing and further acknowledge that such a reaction is possible.

I acknowledge that infection is always possible as a result of obtaining a piercing particularly in the event that I do not take proper care of my piercing and I have been advised of the signs and symptoms of infection that indicate a need to seek medical care.

I acknowledge receipt of instructions on proper care of my piercing and agree to follow all instructions concerning the care of my piercing.

I understand that any healing time advised is approximate and that it is different for each individual.

I acknowledge that obtaining this piercing is my choice alone and will result in a permanent change to my appearance and that no representation has been made to me as to the ability to later restore the skin involved in this piercing to its pre-piercing condition.

I fully release Epic Tattoos, and all associated staff from any claims, liabilities, or damages arising from the body
piercing procedure, including any aftercare advice or instructions

Any questions I had about the piercing procedure have been answered to my satisfaction.

Client Signature: *

Tap or click on the signature above to sign

Parent/Gurdian Signature (Under 18):

Tap or click on the signature above to sign

Data Protection and Privacy

We are committed to protecting your privacy. We take special precautions with your sensitive personal data and we will process your data lawfully and as described. We only process the data we need for as long as we need to and we respect all of your rights under GDPR. We will never sell, share or otherwise abuse your data. You can contact us at any time to request your data, change your preferences or request that your data be deleted. GDPR is the European privacy law designed to protect you and give you control of your data.