Piercing Consent Release Forms
PLEASE READ AND CHECK THE BOXES BELOW, THAT YOU UNDERSTAND THE IMPLICATIONS OF SIGNING THIS DOCUMENT
In consideration of receiving a Piercing from Jennifer Bates, Abigail Burns, Lisa Crockett, John Carlson, Kiana Rivera, the Practitioner located at Curated Body Piercing Studio in Murrieta, CA.
I confirm the following by initialing on each line I am not under any type of doctor care for Diabetes, Cardiac Valve Issues, bleeding issues, hemophilia, or anemia. Or I am not taking any medication that can cause excessive bleeding. I am not required to take any medications such as antibiotics before any dental or medical procedure. I am not pregnant if applicableI am not under the influence of any kind including but not limited to: Alcohol, drugs both prescribed & illicit that would alter my decision making. I am not allergic to any latex or antibiotics. I do not have any other risk factors for blood borne pathogen exposure. You ever had a herpes outbreak in the area being pierced? If you do have any of the following, please stop filling out form and speak to your Artist.
I am the person, of legal age, that ID was presented and that I am at least 18 years old, or a parent or legal guardian will be required to provide their Identification as well.I understand that there is always a chance of allergy, rejection,or failure of the Tattoo. Even with full and proper piercings, aftercare and all there is always a chance that my body will not tolerate the piercing
I understand there is always a possibility of contracting an infection and that I have been advised on when to seek proper medical care
I agree to follow all aftercare instructions, that includes boththe piercing aftercare and healing time requirements before changing the piercing.
I understand that I may feel lightheaded or dizzy before, during or even after the procedure, I have eaten and been well hydrate before my piercing appointment today. I will notify my piercer immediately if I start feeling ill.
I understand that under extreme circumstances, nerve damage, bleeding, bone or tooth loss, tissue damage or scarring. I understand that although the piercer will do everything in their power to prevent this from happening, but they are not responsible for any negative outcomes. Please seek medical care immediately if you are seeing any signs of infection.
I will receive aftercare instructions from the piercer both verbally and printed. Also be aware that the aftercare will be available on our Instagram & Website
I understand that under certain circumstances, photography both still and video may be used in promotional uses. This will include but not limited too TikTok, Instagram, Facebook, Google, Yelp…etc. If you chose to not be photographed, please inform your piercer, we will not use your images. There is monitoring by surveillance, via video at all times for the safety of our staff. No images from this will be used for social media purposes.
I,__________________________________ have been fully informed of the risks associated with the piercing I have hosen to receive. Including but not limited to, infection, other medical complications, allergic reactions, latex or iodine allergy, and the [possible use of antibiotics. Having been informed I still wish to proceed with the piercing.