Piercing Consent Form

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Please note Kim cannot pierce any persons that:

Are on blood thinners that have to carry an anticoagulant alert card.

Are currently on antibiotics.

Are on Accutane (Isotretinoin). Persons must have been off these 6 months prior to getting pierced.

Are pregnant or breastfeeding.

Please be aware that you cannot give blood for 3 months after getting pierced.

Those 16 and over MUST have a physical photo ID (please attach below where asked).

No swimming for 2 weeks after getting a fresh piercing and avoid direct sunlight for at least 2 weeks.

Persons getting pierced MUST have eaten prior to getting pierced, especially if you are prone to fainting! There is a shop next door or a sweet bowl at recpection.

Are you a parent/guardian consenting for someone else?

Relation to client

Preferred pronouns of client (If applicable)

First name of person getting pierced

Last name of person getting pierced

Multi-line address

Country/Region

Address

City

Zip / Postal code

Date of Birth of person getting pierced

Day

Month

Year

Email

Contact number of client or parent/guardian

Proof of ID of client or Parent/Guardian that is consenting (If applicable)

How many piercings are you getting today?

Do you have any allergies?

Please state any allergies

Are you taking any medications?

Please state any medications

I confirm that I or the person I am consenting for is not pregnant or breastfeeding.

I confirm that I or the person I am consenting for is not under the influence of alcohol or drugs.

I confirm that I or the person I am consenting for have eaten prior to getting pierced (not eating puts you more at risk of fainting).

Please note, any piercing of the skin has the potential to lead to infection. It is therefore important to keep the area around the piercing as clean as possible. Your piercing is carried out using sterlisied equipment and jewellery.

I declare that I have read the above information and fully understand and accept the piercing procedure.

I confirm that I understand that the piercer is NOT responsible for the way I or the person I am consenting for treats the piercing once I/we have left the premises.

Signature of client or parent/guardian consent

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