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By checking the box below, answering the following questions, and signing, you agree that:
Being of sound mind, of my own free will, and not under the influence of alcohol and/or drugs, I do hereby release Barbella Studios, High Priestess, HTC Studios, Ten Tigers, or any other DBA of Best Studio Ever, INC., their employees, agents, and/or representatives (hereby collectively referred to as Best Studio Ever) from all liabilities and responsibilities regarding my piercing(s) performed by Best Studio Ever.
In addition I agree not to sue Best Studio Ever in connection with any and all damages, claims, demands, rights and causes of action of whatever kind or nature, based upon injuries or property damage to, or death of myself or any other persons arising from my decision to have piercing related work done, whether or not caused by any negligence of the piercer or Best Studio Ever.
I understand that I am responsible for taking proper care of my piercing(s) and that any infection or damage resulting from not following suggested aftercare procedures is my responsibility and not the responsibility of Best Studio Ever. I have received and had full opportunity to review all written information and instructions regarding piercing risks and proper aftercare procedures. I agree that I have been given full and fair opportunity to ask any and all questions that I may have about obtaining piercings from Best Studio Ever and that all of my questions have been answered to my full and total satisfaction. I further agree to call or otherwise personally contact Best Studio Ever with any questions and or concerns I have during the duration of the healing process or thereafter. Additionally, I understand that Best Studio Ever is not responsible for any possible effect my new piercing(s) may have on any other preexisting piercing(s).
I represent and warrant to Best Studio Ever, under penalty of perjury, that the information supplied on this form is true, complete, and correct to the best of my knowledge and that I understand the terms of this release.

I Agree

 

By checking the box below you agree that you have read an understand Oregon's Informed Consent - Specialty Level One and Two

Informed Consent is both a process and a document - neither can stand alone as informed consent. The informed consent process must contain a verbal review of the procedures, alternates, and risks of the piercing procedure, as set out below, as well as the opportunity for the client to ask the piercer any question about the piercing. The informed consent document must be signed by you, the client.

Procedures:

Specialty Level One Male Genital Piercing: A specialty level one male genital piercing includes surface piercing (where the piercing has a point of entrance and a point of exit) of the scrotum, frenum, foreskin, or the perineum behind the scrotum, and the piercing of the penis through the urethra and the exit on the underside of the penis (called a “Prince Albert).

RISKS: The genital surface piercings are susceptible to infection due tho the closed in nature of the genital area of the body and limited air circulation. Because of the constant irritation from clothing and general movement, these piercings may take longer to heal. The jewelry inserted into the penis may limit the effectiveness of condoms by causing tears. Imprecise piercing may damage nerves and blood vessels located in the penis. Healing time may be from 6-8 weeks for the foreskin or penis, to 3-4 months or longer for the frenum or perineum. Infection or allergic reaction may extend the time required for healing. Neglecting appropriate aftercare may increase likelihood of infection and extend healing time.

Specialty Level One Female Genital Piercing: Specialty level one female genital piercing includes surface piercing (where the piercing has a point of entrance and a point of exit) of the labia major, labia minor, frenulum labiorum pudenda, (the perineum between the vagina and the anus), and a vertical piercing of the clitoral hood (called a “Princess Diana”).

RISKS: The genital surface piercings are susceptible to infection due to the closed in nature of the genital area of the body and limited air circulation. Because of the constant irritation from clothing and general movement, these piercings may take longer to heal. Imprecise piercing my damage nerves and blood vessels located in the genitals. Healing time may be from 4-8 weeks for a piercing of the clitoral hood, 6-8 weeks for the frenulum labiorum and labia minor, to 3-4 months or longer for the labia major. Infection and allergic reaction may extend time required for healing. Neglecting appropriate aftercare may increase likelihood of infection and extend healing time.

Specialty Level Two Male Genital Piercing: A specialty level two male genital piercing includes a vertical piercing of the head of the penis that passes through the urethra (called an “Apadravya”). a horizontal piercing of the head of the penis that passes through the urethra (called an “Ampallang”), a piercing through the corona or edge of the head or glans of the penis, a piercing of the penis entering through the urethra and exiting in the upper side of the penis (called a “Reverse Prince Albert”).

RISKS: The genital piercings are susceptible to infection due to the closed in nature of the genital area of the body and limited air circulation. Because of the constant irritation from clothing and general movement, these piercings may take longer to heal. The jewelry inserted into the penis may limit the effectiveness of condoms by causing tears. Imprecise piercing of the glans may damage nerves and blood vessels located in the penis. Healing time may be from 3-4 months for the corona of the glans, 4-6 months for a vertical or horizontal piercing of the head or glans of the penis. Infection or allergic reaction may extend time required for healing. Neglecting appropriate aftercare may increase likelihood of infection and extend healing time.

Specialty Level Two Female Genital Piercing: Specialty level two female genital piercing includes piercing of the clitoris, a horizontal piercing beneath the shaft of the clitoris (called a “Triangle”), and a piercing of the base of the vagina exiting through the urethra (called a “Princess Albertina”).

RISKS: The genital piercings are susceptible to infection due to the closed in nature of the genital area of the body and limited air circulation. Because of the constant irritation from clothing and general movement, these piercings may take longer to heal. Imprecise piercing may damage nerves and blood vessels located in the genitals. Imprecise piercing the clitoris or behind the clitoral shaft may result in significant irreparable nerve damage. healing time may be from 4-8 weeks for a piercing of the clitoris, 3-4 months or longer for a piercing behind the clitoral shaft, and a piercing through the urethra. Infection and allergic reaction may extend time for required healing. Neglecting appropriate aftercare may increase likelihood of infection and extend healing time.

ALTERNATES: As with any elective procedure, you have the option or alternative to choose a different procedure or to decline the procedure.

 

I Agree

 

 

 

 

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Tenth Client's Name

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What service will we be providing today?
Select your service*

If this is for a new piercing, what piercing will you be receiving?
Please answer "yes" or "no" to the following questions.
Have you ever fainted before?*
Does your doctor require antibiotics before dental work?*
Have you: (check all applicable options below) Consumed alcohol, caffeine, ibuprofen, or other blood thinners in the last 24 hours? Not eaten food in the last 4 hours? Been sick recently? Attention: These are issues which could effect you piercing procedure and/or healing process, by checking yes you agree to discuss these concerns with your piercer.*
Please check any option that apply to you
I have not eaten food in the last 4 hours
I have consumed caffeine in the last 24 hours
I have consumed alcohol in the last 24 hours
I have consumed ibuprofen in the last 24 hours
I have been sick recently
Do you have any medical conditions that may potentially complicate the piercing procedure and/or healing process? Such as, but not limited to: (check list applicable conditions below) anemia, diabetes, epilepsy, hemophilia, hepatitis, hypoglycemia, and immune deficiency disease or disorder, if you are nursing (breast feeding) or pregnant, or take blood thinning medications.*

If yes to the previous question, please list applicable conditions
Do you have any known sensitivities or allergies to iodine?*

Please list any other heart, medical, skin conditions, sensitivities, allergies, or diseases.
Please attach a photo of your state or government issued photo ID. (Please note: You will also need to provide your ID in person when you arrive for your appointment)
  
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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.
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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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