Body Piercing Consent Form | OLD CITY TATTOOS

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Artists
Care and Information
Booking

Intricate gothic stone carvings on the exterior of a cathedral against a blue sky

Old city tattoos

BODY PIERCING CONSENT FORM

TODAY'S DATE*

PIERCER NAME*

AREA TO BE PIERCED*

I UNDERSTAND THAT A PIERCING IS A PERMANENT CHANGE TO MY BODY.*

Yes

No

I UNDERSTAND THAT PIERCING SERVICES ARE NON REFUNDABLE. THIS INCLUDES IF I CHOOSE THE JEWELLERY AND THE PLACEMENT THEN DECIDE AFTERWARDS THAT I DO NOT LIKE THE PIERCING.*

Yes

No

I UNDERSTAND THAT FAILURE TO COMPLY WITH THE RECOMMENDED AFTERCARE PROCEDURES CAN HAVE A NEGATIVE EFFECT ON THE WELLBEING OF MY PIERCING.*

Yes

No

I CONFIRM THAT I WILL FOLLOW ALL AFTERCARE PROCEDURES AND ADVICE EXPLAINED TO ME BY MY PIERCER.*

Yes

No

I AM NOT UNDER THE INFLUENCE OF ALCOHOL OR DRUGS.*

Yes

No

I CONSENT TO ANY PICTURES TAKEN TO BE USED BY THE ARTIST FOR SOCIAL MEDIA AND ADVERTISING PURPOSES.*

Yes

No

ARE YOU PREGNANT OR BREASTFEEDING?*

Yes

No

ARE YOU PRONE TO FAINTING OR PANIC ATTACKS?*

Yes

No

DO YOU SUFFER FROM ANY HEART CONDITIONS SUCH AS PROSTHETIC HEART VALVE, HEART VALVE DISEASE, ANGINA OR BLOOD PRESSURE PROBLEMS?*

Yes

No

DO YOU SUFFER FROM EPILEPSY?*

Yes

No

IF YES, HOW CONTROLLED?

DETAILS

DO YOU SUFFER FROM HAEMOPHILIA OR OTHER CLOTTING DISORDERS?*

Yes

No

DO YOU SUFFER FROM ANY KNOWN BLOODBORNE VIRUS SUCH AS HEP B, HEP C, HEP D OR HIV?*

Yes

No

DO YOU SUFFER FROM DIABETES OR LUPUS?*

Yes

No

DO YOU SUFFER FROM ANY PROBLEMS WITH SKIN HEALING IN THE PAST, SUCH AS PSORIASIS OR ECZEMA?*

Yes

No

DO YOU SUFFER FROM ANY LUMPY OR RAISED SCARS, ALSO KNOWN AS KELOID SCARS?*

Yes

No

DO YOU SUFFER FROM ANY KNOWN ALLERGIC RESPONSES SUCH AS PLASTERS, CREAMS, METALS, IODINE, SHELLFISH, LATEX, FOODSTUFFS OR OTHER ALLERGIES?*

Yes

No

IF YES, PLEASE INDICATE WHICH

DETAILS

DO YOU TAKE ANY PRESCRIBED MEDICATION REGULARLY, ESPECIALLY ANTICOAGULANTS SUCH AS WARFARIN OR HIGH DOSE ASPIRIN, OR IMMUNOSUPPRESSANTS SUCH AS STEROIDS?*

Yes

No

IF YES, PLEASE INDICATE WHICH

ANY OTHER INFORMATION YOU THINK WE SHOULD KNOW?

Your piercing aftercare instructions will be provided as a PDF on the confirmation page after you submit this form. I understand that it is my responsibility to download and read the aftercare instructions provided by Old City Tattoos and to follow them carefully throughout the healing process. I understand that following the aftercare instructions is important to help support the proper healing of my piercing and to minimise the risk of irritation, infection and other complications.

I CONFIRM THAT I WILL DOWNLOAD, READ AND FOLLOW THE AFTERCARE INSTRUCTIONS PROVIDED BY OLD CITY TATTOOS.*

I agree

I hereby declare that I am of legal age, with valid proof of age, and that I am competent to sign this agreement. If I am not of legal age, my parent or legal guardian must sign on my behalf and confirm their understanding and agreement with this form.

LEGAL NAME*

ADDRESS

POSTCODE

DATE OF BIRTH*

AGE

PHONE NUMBER*

EMAIL*

SIGNATURE*

PARENT / LEGAL GUARDIAN - I, as the custodial parent or legal guardian of the above minor, hereby consent to the terms and conditions set forth in this release form and I confirm that all documentation I have provided is true and accurate.

LEGAL NAME

SIGNATURE

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

NAME

PHONE NUMBER

I confirm that all information I have provided in this form is true and accurate to the best of my knowledge. I confirm that I have read and understood the information provided, including the potential risks associated with piercing and the aftercare advice, and that I have had the opportunity to ask any questions before proceeding. I give my full and informed consent to the piercing being carried out by the named piercer. I understand that it is my responsibility to download, read and follow the aftercare instructions provided by Old City Tattoos.

I CONFIRM THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE DECLARATION.*

I agree

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