Please read carefully
- I understand that any piercing is a potential entry for infection,
-
I have completed this form honestly
- I am over the age of 16 or accompanied by a parent or guardian.
-
That I am solely responsible for caring for the piercing as instructed after
I have left the piercing studio
Name of person to be pierced..............................................................................................
Male....................... female.....................Tel no...................................................................
Address...............................................................................................................................
..........................................................
.................................................................................
.............................................................................................................................................
Piercing........................................... Any other info..............................................................
Jewellery (to be completed by piercer )................................................................................
Signed.................................................................................Date.............../............./...........
Only to be completed if UNDER 16 years of age
Age.........DOB........./........../........
Parental/ Guardian Consent Signed..................................
Relationship.............................................Name....................................................................
Address if different................................................................................................................
.....................................................................................................................
* Guidelines for piercing, risks and aftercare are displayed, please read
and understand before proceeding
* We have discussed and agreed upon the suitable jewellery
* The needle and jewellery are both in sterile packaging and unopened
* You have had verbal and written aftercare instruction
* You will be unable to give blood for 12months after a piercing
* Medical conditions relevant have been declared and discussed
Please read
Medical Conditions Noticeand declare any relevant condition
.
...................................................................................
(or postpone until advise has been sought by Dr)