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Consent Form (Piercing)
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
•Piercing Location: [Piercing Location]
•Jewelry Style: [Jewelry Style]
•Jewelry Material: [Jewelry Material]
•Gauge/Size: [Jewelry Gauge]
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 that piercing punctures the skin and creates a wound that requires proper care to heal.
I understand risks include infection, scarring, keloid formation, allergic reactions, migration, rejection, and nerve sensitivity changes.
I agree to follow all aftercare instructions provided to me.
I understand that healing time varies by placement and individual, and that outcomes cannot be guaranteed.
I understand that changing jewelry before the piercing is fully healed can cause complications.
I had the opportunity to ask questions before the procedure.
I consent to documentation photos.
I confirm that the decision to get this piercing is entirely my own, and I consent to the piercing procedure.
Health and Safety Screening
I am not under the influence of alcohol or drugs.
I am feeling well today.
I have disclosed any relevant medical information below.
•Known metal or material allergies?
Yes — describe: [Allergy Details]
No
•Blood-thinning medications or bleeding disorder?
Yes
No
•Diabetes?
Yes
No
•Immune system conditions or immunosuppressant medications?
Yes
No
•Heart condition or pacemaker?
Yes
No
•Pregnant or nursing?
Yes
No
•Skin conditions at or near the piercing site?
Yes — describe: [Skin Condition Details]
No
Other health notes::
Minor / Guardian Section *(complete only if client is a minor)*
Laws regarding piercing minors vary by location. Verify your local requirements before proceeding.
Guardian Name: [Guardian Name]
Relationship to Minor: [Guardian Relationship]
I am the legal parent or guardian of the above-named minor and consent to this piercing.
I will be present for the procedure.
Guardian Signature: ______ Date: ______
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Client Signature: ______ Date: ______
Piercer/Staff Signature: ______ Date: ______