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Dermal Anchor (Microdermal) Consent Form

A dermal anchor consent form is the document a client signs before a dermal anchor, or microdermal, piercing. This single-point piercing has a small base under the skin and a top on the surface. It carries different risks than a standard piercing, so the form covers placement, rejection, and removal.

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Consent Form (Dermal Anchor / Microdermal)

Studio: [Studio Name]

Piercer: [Piercer Name]

Client: [Client Name]

Appointment: [Appointment Date] at [Appointment Time]

Client Information

•Phone: [Client Phone]
•Email: [Client Email]
•Date of Birth: [Client Dob]

Piercing Details

•Placement: [Piercing Location]
•Number of Anchors: [Anchor Count]
•Anchor Base Style: [Jewelry Style]
•Jewelry Material: [Jewelry Material]
•Top Style: [Top Style]
I approve the placement marked on my skin. I looked at it in a mirror and I'm happy with the location and spacing.

Please read and initial each item

I confirm I meet the legal age requirement for this piercing.
My identity and age will be verified with a valid photo ID.
I understand a dermal anchor is placed through one small opening. The base sits under my skin, and the top attaches to it on the surface.
I understand my body may push the anchor toward the surface or out completely. This is called rejection or migration. It can happen even after the piercing has healed.
I understand anchors can catch on clothing, towels, hair, and bedding. Snagging can cause irritation, bleeding, or pull the anchor out. Spots that rub a lot carry more risk.
I understand a dermal anchor must be removed by a professional piercer or a doctor. I won't try to remove it myself.
I understand top changes should be done by my piercer, especially while healing. Changing the top too early or the wrong way can irritate or loosen the anchor.
I understand a small scar may remain if the anchor is removed or rejects.
I understand other risks include infection, keloid formation, allergic reaction, bumps around the site, and changes in nerve sensitivity.
I understand that healing time varies and outcomes can't be guaranteed.
I agree to follow all aftercare instructions provided to me.
I had the chance to ask questions before the procedure.
** I consent to documentation photos.
The decision to get this piercing is my own, and I consent to the procedure.

Health and Safety Screening

I am not under the influence of alcohol or drugs.
I am feeling well today.
•Known metal or material allergies?
Yes, describe: [Allergy Details]
No
•Blood-thinning medications or bleeding disorder?
Yes
No
•Keloid or raised scarring history?
Yes
No
•Diabetes?
Yes
No
•Immune system conditions or immunosuppressant medications?
Yes
No
•Pregnant or nursing?
Yes
No
•Skin conditions at or near the placement?
Yes, describe: [Skin Condition Details]
No
Other health notes:: 

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Client Signature: ______ Date: ______

Piercer/Staff Signature: ______ Date: ______

Tips for using this form

  • • Talk through placement and daily life. Spots that rub on waistbands, straps, or collars snag more
  • • Mark the placement and have the client approve it in a mirror before you start
  • • Record the base, top, and material so any future piercer knows what's in there
  • • Tell clients you can remove it for them, and that they should never try it at home
  • • Explain that rejection can happen even after healing, so it isn't a surprise later

Frequently Asked Questions

What is a dermal anchor (microdermal) piercing?

A dermal anchor is a single-point piercing. A small base sits under the skin, and a decorative top attaches on the surface. Unlike a standard piercing, there’s no exit hole. That’s why it carries its own risks, like rejection and snagging.

What should a dermal anchor consent form include?

The approved placement, the base and top style, the jewelry material, and clear notes on rejection, migration, snagging, top changes, and professional removal. It should include a health screening and a scarring and keloid question. Finish with signatures from the client and piercer.

Why do dermal anchors reject?

The body can treat the anchor as something to push out. Pressure, snagging, placement in a high-friction spot, and poor aftercare can all raise the risk. Rejection can happen even after healing, so it should be explained before the procedure.

How is a dermal anchor removed?

A trained piercer or a doctor removes it, usually through the same small opening. It may leave a small scar. Clients should never try to remove a dermal anchor at home.

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Related Templates

Piercing Consent Form Template Piercing Aftercare Instructions Template Tattoo Health Questionnaire Template

Disclaimer: This template is provided as a general starting point and is not legal advice. Laws vary by location. Consult a lawyer before using this in your business. Apprentice is not responsible for any legal issues arising from the use of these templates.

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