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Consent Form (Scarification)
Studio: [Studio Name]
Artist: [Artist Name]
Client: [Client Name]
Appointment: [Appointment Date] at [Appointment Time]
Client Information
•Phone: [Client Phone]
•Email: [Client Email]
•Date of Birth: [Client Dob]
Procedure Details
•Technique:
Cutting
Skin removal
Strike branding
Other heat branding: [Technique]
•Placement: [Placement]
•Design Size: [Design Size]
I approve the final design, size, and placement as drawn or stenciled on my skin.
Age and ID
I confirm I am 18 or older and have shown a valid government photo ID. I understand this studio does not perform scarification on minors.
Please read and initial each item
I understand scarification is permanent. It can't be removed or reversed, and options to change or hide it later may be limited.
I understand the final result depends on how my skin scars. Lines may heal raised, flat, wider, thinner, lighter, darker, or uneven. Parts of the design may heal less visible than expected. The exact result can't be predicted or guaranteed.
I understand healing can take months, and the scar may keep changing in color and texture long after the surface has closed.
I understand that a history of keloids or raised scars raises my risk of thick, raised scarring. I have answered the screening question about this below.
I understand risks include pain, bleeding, infection, excess scarring, keloids, skin color changes, changes in nerve sensitivity, and a result that doesn't match the design.
I will follow the aftercare instructions from my artist. I won't irritate, pick, scrub, or otherwise work the wound to change how it scars unless my artist tells me to and explains how.
I will seek medical care if I see signs of infection, such as spreading redness, heat, pus, or fever.
I am not under the influence of alcohol or drugs.
I had the chance to ask questions before the procedure.
I consent to photos of the design and the work for my client record.
** I consent to photos for the artist's portfolio and marketing. I can say no without it affecting my procedure.
I have had time to think about this decision. It is my own, and I consent to the procedure described above.
Health and Safety Screening
•Keloid or raised scarring history?
Yes
No
•Blood-thinning medications or bleeding disorder?
Yes
No
Don't stop a prescribed medication without talking to your doctor.
•Diabetes or a condition that slows healing?
Yes
No
•Immune system conditions or immunosuppressant medications?
Yes
No
•Accutane in the past 12 months?
Yes
No
•Pregnant or nursing?
Yes
No
•Pacemaker or other implanted medical device?
Yes
No
•Skin conditions at or near the placement?
Yes, describe: [Skin Condition Details]
No
•Known allergies (latex, topical products, other)?
Yes, describe: [Allergy Details]
No
Other health notes::
I certify that I have answered these questions truthfully and to the best of my knowledge.
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Client Signature: ______ Date: ______
Artist/Staff Signature: ______ Date: ______