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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, Deep Roots Tattoo & Body Piercing, 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 and understand Oregon's Informed Consent

 

Informed Consent is both a process and a document - neither can stand alone as informed consent. The informed consent process must include a verbal review of the procedures, alternates, and risks of the piercing procedure, as set out below, as well as an opportunity for the client to ask the piercer any questions about the piercing. The informed consent document must be signed by you, the client, or legal guardian (if the client is under 18)

Procedures

General body piercing: A piercing of the body that has a point of entry and a point of exit that is mad for ornamentation or decoration. Jewelry may be inserted into the piercing opening for decoration and to prevent closure of the opening.

RISKS: Any body piercing may become infected and may result in an allergic reaction to the jewelry. Certain parts of the body, for example the cartilaginous portion of the upper ear, may be more susceptible to infection because of reduced blood flow and therefor reduce exposure to immune system activity. Depending on the area of the body that is pierced, imprecise piercing may damage nerves, blood vessels or ducts located in that area. Healing time ranges from 6-8 weeks (e.g., a pierced earlobe), to 6-9 months or longer (e.g., a pierced navel). Neglecting appropriate aftercare may increase likelihood of infection and extending healing time. Scarring following removal of the jewelry may be permanent. If you have experienced keloid scarring or are susceptible to keloid formation, be aware that piercing procedures may result in keloid scarring.

Cheek Piercing: A piercing of the face that goes through the cheek, creating an opening to the oral cavity. Jewelry is inserted and held in place by a flat disk on the inside of the mouth.

RISKS: A piercing through the cheek may become infected and may result in allergic reaction to the jewelry. The cheek is relatively thick tissue and is rich in blood vessels, nerves and glands. Cheeks contain the ducts carrying saliva from the salivary glands to the mouth, making appropriate placement of the piercing critical. Imprecise piercing may damage nerves, blood vessels or ducts located in the cheek. Cheek piercing openings may weep saliva. Healing time may be from 6-9 months or longer. Scarring following the removal of the jewelry may be permanent. If you have experienced keloid scarring or are susceptible to keloid formation, be aware that piercing procedures may result in keloid scarring. Neglecting appropriate aftercare may result increase likelihood of infection or extend healing time.

Single Point Piercing: Also known as dermal anchor or microdermal piercing, consists of a piercing point of entry but not a point of exit. Pecially designed jewelry is inserted into the piercing area and sits below the skin where it becomes anchored, leaving the jewelry exposed on the surface of the skin.

RISKS: A single point piercing may become infected. The risk of infection may be greater depending where on the body the piercing is located, There is the possibility of allergic reaction. The process of piercing may damage nerves located in the area that is pierced.The “anchor” portion of the jewelry may become embedded in the skin and need to be removed surgically. Scarring following removal of jewelry may be permanent. Healing time may be from 6-8 weeks. Neglecting appropriate aftercare may increase likelihood of infection and extended healing time.

Nape piercing: A surface piercing on the back of the neck with and entry and exit. Jewelry, usually a surface bar or barbell is inserted in the piercing opening.

RISKS: This piercing may become infected. The process of piercing may damage nerves located in the area that is pierced. Because of its location, the nape piercing may be irritated by clothing, which may increase the chance for infection and extend healing time. Healing time may be from 6-9 months. 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 decline the procedure.

NOTE: OAR 331-900-0010 prohibits piercing the nipples of any person under the age of 18, even with parental consent.

I Agree

 

 

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First Client's Name

First Name*

Middle Name

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information

Preferred name (if different)

Pronoun (Optional)

What is your full adress? *
First Client's Signature*
Guardian's Email Address

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What service will we be providing today?
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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 options 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 past 24 hours
I have used ibuprofen in the past 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.
Guardianship agreement
Is this form for a minor? If yes, do you understand that by signing on behalf of this minor you are CLAIMING LEGAL GUARDIANSHIP and that by doing so without proper consent, legal action may be taken against you?*
Please attach a photo of your state or government issued photo ID. For minors, please upload a photo of the parent or guardian's ID. (Please note: You will also need to provide your ID in person when you arrive for your appointment)
  
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Valid file types: JPG, GIF, PNG, and PDF
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.
Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

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

Preferred name (if different)

Pronoun (Optional)

What is your full adress? *
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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