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INFORMED CONSENT, RELEASE AND WAIVER                                                       
IRON BRUSH TATTOO STUDIO 

226 S. 16th, Lincoln, NE 68508 (402)-474-5151   


Agreement for Services: In consideration of the services of Iron Brush Tattoo and Body Piercing Studio, its corporation, owners, agents, employees, independent contractors, and all other persons or entities associated with Iron Brush Tattoo and Body Piercing Studio (collectively referred to as the “Studio”), I state that I am acting voluntarily, and I fully consent to the application of body piercing and body jewelry on my body and to any other actions of the Studio which are reasonably necessary to perform the body piercing procedure. The Studio does not recommend any topicals or numbing cream the customer may apply and assumes no responsibility or guarantees for their use. 

   Risk Notification: I am aware that the application of body piercing and body jewelry (hereinafter referred to as “body piercing”) entails risks to myself and I acknowledge that the Studio has informed me and advised me of these risks both orally and in writing. I understand that the risks described below, and the risks which have been discussed with me today may not be complete and that there may be unknown or unanticipated risks which may result in injury to me. I agree to assume responsibility for the risks identified below, as well as those risks which are not specifically identified. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, and reactions; allergic and otherwise. I understand that I may also be exposed to jewelry, aftercare products, soap, cleaners, and/or other materials including latex. Migration or rejection of the piercing may be possible. I understand that in oral piercings the jewelry may cause damage to the teeth or other oral structures. I understand that I may experience discoloration, swelling, indurations or excretion in the area of the piercing. I understand and acknowledge that body piercing is a permanent change to my appearance, and that it may leave a blemish or scar, and that my skin may not ever be restored to its pre-piercing condition even after its removal. The Studio has not made any representations to me regarding my ability to later remove or alter any such blemish. I understand the Customer assumes responsibility for all risks known and unknown.

      I acknowledge that I have been given the full opportunity to ask questions that I might have about body piercing and the care and treatment of body piercing. I acknowledge that all my questions have been answered to my full and total satisfaction.

      I hereby certify that my answers to the following questions are accurate and I understand that the Studio will rely upon my answers for the body piercing procedure.

   Description of Body Piercing procedure: Each client must completely fill out this Informed Consent, Release & Waiver for Body Piercing form and show proof of age. The body piercer will discuss aftercare of the body piercing and address any questions the client may have prior to initiating the body piercing. Sterile instruments and jewelry are set up for each client. The area to be pierced is cleaned with an approved cleaning product. A needle is inserted into the tissue, followed directly by the jewelry. Upon completion, the piercing is washed, and dressed as necessary.

           Waiver of Claims: I hereby waive any and all claims for any sort of damages including but not limited to costs, expenses or attorney fees that I may have either known or unknown against the Studio and its successors, assigns, owners, agents, independent contractors, and employees, arising out of or connected in any way with body piercing or the procedures used to apply my piercing, unless said claim arises out the willful and gross negligence of any owner, employee or independent contract of the Studio. In the event that an independent contractor of the Studio acts willfully and is grossly negligent, I understand that the Studio is not responsible for said independent contractor’s actions.  This Agreement shall be governed under the laws of the State of Nebraska. 


COVID-19 WAIVER: I understand that I am opting for a service that is not urgent and not medically necessary. I also understand that the coronavirus disease (COVID-19) was declared a worldwide pandemic by the World Health Organization. I further understand COVID-19 is extremely contagious. State and federal health agencies recommend social distancing. I hereby agree to indemnify and hold the Studio harmless and release the Studio from any liability whatsoever should I become infected with COVID-19 which may include but not be limited to claims for personal injury, loss of income, disability, illness and death. Furthermore, I understand that this Agreement is subject to the laws of the State of Nebraska and further agree that the appropriate venue for any dispute involving this Agreement shall be Lancaster County, Nebraska. Given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 if I proceed with this elective service. Accordingly I acknowledge and assume the risk of becoming infected with COVID-19, and any variation of mutation thereof, through this elective service and I gave my express permission for the staff at the Studio to proceed with the same. This consent applies to any follow up of additional services in the upcoming months. I understand that even if I have been tested for COVID-19 and received a negative test result, the tests may not have detected the virus or I may have contracted COVID-19 after the test. I will not hold that business and professional offering the service responsible for any liability related to COVID-19 and variation or mutation thereof. I understand that exposure to COVID-19 before, during, or after my procedure(s) may result in complications and/or delayed healing. I have been given the option to defer my service to a later date. However, I understand all the risks including those noted herein and I would like to proceed with this service. I have been offered a copy of this consent form. I understand the explanation and consent to the procedure(s).

By signing below, I agree to notify my tattooer/piercer immediately if I experience any of the symptoms listed, or test positive for COVID19 in the next 3 days. I understand that the Studio, and its independent contractors, employees, staff and representatives cannot guarantee, with total certainty, that all risk of contracting an illness or virus such as Covid19, has been eliminated.

   I have read, understood and accepted the terms and conditions of this Informed Consent, Release and Waiver for Body Piercing form and acknowledge that it shall be effective and binding upon myself, my heirs, assigns, personal representatives, and estate. I acknowledge that the information contained in this agreement represents the entire agreement and I am not relying on any oral, written, or visual representations or statements made by the Studio, including those in its brochures or other promotional material in the execution of this agreement.

I Agree


February 12, 2025



First Clients Name

First Name*

Last Name*

Phone*
First Clients Date of Birth*
First Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
First Clients Signature*
Second Clients Name

First Name*

Last Name*
Second Clients Date of Birth*
Second Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Third Clients Name

First Name*

Last Name*
Third Clients Date of Birth*
Third Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Fourth Clients Name

First Name*

Last Name*
Fourth Clients Date of Birth*
Fourth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Fifth Clients Name

First Name*

Last Name*
Fifth Clients Date of Birth*
Fifth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Sixth Clients Name

First Name*

Last Name*
Sixth Clients Date of Birth*
Sixth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Seventh Clients Name

First Name*

Last Name*
Seventh Clients Date of Birth*
Seventh Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Eighth Clients Name

First Name*

Last Name*
Eighth Clients Date of Birth*
Eighth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Ninth Clients Name

First Name*

Last Name*
Ninth Clients Date of Birth*
Ninth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Tenth Clients Name

First Name*

Last Name*
Tenth Clients Date of Birth*
Tenth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Body Piercing Aftercare:-Showering: Shower like you normally do, then the last thing you will do is clean your piercing. Lather up some mild non-antibacterial soap in your clean hands and gently wash your piercing. You want enough friction to clean it, but not too much that you cause trauma to the piercing. If you must rotate your jewelry to clean, grab the jewelry and not the piercing. The hot water will also open your capillaries/pores and help flush the area out and bring in oxygen which helps healing.-Sea Salt Soaks: These should be done 1-2 times a day with a ¼ teaspoon of sea salt to one cup of warm distilled water, or 4 teaspoons to one gallon (do not used iodized salt which has an additive to prevent clumping). It should be the temperature of a hot beverage that would be comfortable to drink. Use a shot glass, cup, or bowl to soak the piercing for 10 minutes. Then rinse with distilled water or shower, as mentioned above, to get rid of any salt crystals that might form when dry. You can invert the piercing itself and hold the container of solution tight against the skin to create a seal, then flip back over to soak. You can also soak a sterile gauze in the solution to make a compress to apply to hard to reach piercings. Just like showering, the warm sea salt solution will open up capillaries and pores to flush the area, and increase oxygen.-Saline Cleanings: To be done 2-3 times daily with any generic contact solution (that does not contain hydrogen peroxide), or sterile wound wash. Apply either to a couple of Q-tips and clean each side of the piercing. You can apply a little bit of compression to cartilage piercing to help aid the layers of tissue to heal back together. The first cleaning should be done after shower but the last thing you do before you leave the bathroom. This will clean any hair/body products, or makeup that might have migrated to your piercing. Clean one more time during the day, and before you go to bed. If doing any exceptionally dirty activities make sure to do an extra cleaning afterwards.Oral Piercing Aftercare:-Mouthwash Cleaning: Use a non-alcohol based mouthwash and rinse for at least 30 seconds, 4-5 times daily, or after you eat or drink anything besides water. Your first rinse should be right after you brush your teeth, then repeat after each meal, then once again after you brush your teeth at the end of the day. In a pinch, you may also dilute an alcohol based mouthwash with water 50/50. Eat, drink, and talk like you normally would, but take care not to play with the jewelry until it is healed. There may be some swelling, which is normal because the mouth is always moving when talking, eating and drinking. You may gently chew on some ice chips to help alleviate the swelling. Avoid excessive smoking and drinking of alcohol, but if you are a heavy smoker add an extra mouthwash rinse.What to Expect:The first few days after the piercing you may notice bleeding, swelling, and some bruising. These are all normal symptoms of a healthy piercing. Your body is trying to flood the wounded area with blood and plasma to achieve hemostasis, when your blood clots to prevent further bleeding.In the next few weeks/months your body will produce a base layer of cells made up of collagen and protein that will grow through the piercing and around the jewelry. The skin will also start to contract and tighten around the jewelry. New skin cells will start to form at both edges of the piercing and grow inwards to connect up and form a fistula (flesh tunnel). This process causes a clear to yellow color liquid discharge made up of dead cells and other fluids. These fluids dry into what are commonly called "crusties".At this stage the initial healing is complete but it will take more months for the skin to mature and strengthen. Care must still be taken, because any trauma or bumping of the piercing may cause it to regress back to an earlier stage in the healing process.DO NOT TOUCH YOUR PIERCING!:This is a major cause of infection. Your hands come into contact with many types of dirty environments on a daily basis. If you must touch your piercing make sure to thoroughly wash your hands first.-Make sure to change bedding and towels at least once a week, and wear clean clothes around the piercing.-Disinfect all objects that come in to contact with your piercing; phones, ear-buds, etc.-Try not to sleep on the piercing, bump or cause any trauma to it.-A healthy diet, a good nights sleep, drinking plenty of water, and taking daily vitamins will help with the healing process-Avoid stress, alcohol, excessive caffeine and smoking-Avoid tanning because it may cause permanent discoloration in the new skin formed around the piercing.-Exercise: You should be fine with most exercise as long as you are not bumping causing trauma to your piercing, or exposing it to any dirty surfaces or environments. Your sweat is sterile to you so just shower like you would normally and cleanse the piercing with saline, as mentioned above.
I acknowledge receipt of a copy of this form. I affirm that the Studio has given me written and oral instructions on the procedure, precautions, risks and instructions for care for my body piercing and I understand the instructions and will follow them. I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions given to me. I understand that body piercing can take several weeks to several months to heal properly. Having been informed of the potential risks associated with body piercing, I wish to proceed with the body piercing and I freely accept and expressly assume any and all risks that may arise from this body piercing. I understand and acknowledge that I might experience an infection or other potentially serious conditions as a result of obtaining a tattoo or as a result of not properly caring for the tattoo especially if I do not follow the Studio's instructions on how to properly care for my tattoo. I agree that I will promptly call the Studio with any questions about the condition of my piercing or seek medical care of any sign of infection or other condition that appears to be related to the piercing or any other service performed by the Studio.*
Yes
No
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR PIERCING. Thank you

Consent forms must be filled out the day of the appointment. *

Todays Date:
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (a VAILD drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the piercing area? *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions?
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing:
Are you sunburned or have a rash or any other skin irritations in the location for the piercing?*
Yes
No
Do you have any medical contradictions to getting a piercing? *
Yes
No
Have you ever been told by a medical professional not to get a piercing for any reason? *
Yes
No
I understand there is greater risks in getting a piercing, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of piercing on body *

Description of piercing: *
Which piercer is doing your piercing?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use your picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the fin ished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the piercing procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the piercing or todays piercing procedure? *
No
Yes

List conditions that could cause complications for the piercing or todays piercing procedure?
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore Throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the piercing artist any physical, emotional, or mental conditions that put me or the piercing artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a piercing. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a piercing and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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