BODY PIERCING FORM

BODY PIERCING FORM

First name

Last name

Birthday

Phone

Address

EMERGENCY CONTACT

PHONE NUMBER

DRIVE LICENSE

Have you had a piercing before?

Yes

Do you have any medical conditions or take any medications that may affect healing?

Yes

Do you have any allergies? (e.g., metals, latex, medications)

Yes

Aftercare Instructions

Cleaning Your Piercing
- Wash your hands thoroughly with soap and water before touching your piercing.
- Clean the piercing twice a day with a sterile saline solution or a piercing-specific aftercare product.
  - To clean:
    - Soak a sterile gauze or cotton pad in the saline solution.
    - Gently clean around the piercing, removing any crusted material.
    - Do not twist, rotate, or move the jewelry.
- Avoid using alcohol, hydrogen peroxide, or harsh soaps, as these can irritate the skin.
Avoid Touching or Fiddling
- Do not touch, twist, or play with the jewelry.
- Avoid letting others touch your piercing to reduce the risk of infection.
Keep It Dry and Clean
- Avoid submerging your piercing in pools, hot tubs, lakes, or oceans until fully healed.
- Gently pat the area dry with a clean paper towel after cleaning or showering.
Protect the Area
- Avoid tight clothing or anything that might irritate or snag the piercing.
- Be cautious when using headphones, helmets, or hats (for ear or facial piercings).

Signs of Infection:

Seek professional advice if you notice redness, swelling, yellow discharge, or persistent pain.

For the full aftercare guide and healing timelines, please refer to the attached instructions.

Healing Times

Healing times vary based on the location of the piercing:

Earlobe: 6–8 weeks
Cartilage: 4–12 months
Nose: 2–6 months
Belly Button: 6–12 months

Contact Us for Support: 512-251-4170

Acknowledgment of Aftercare Responsibility

I, the undersigned, acknowledge that I have received detailed aftercare instructions for my new piercing and understand the importance of following these guidelines to ensure proper healing. I am aware that improper aftercare, negligence, or failure to follow the provided instructions may result in complications, including infection, irritation, or rejection of the piercing.

I understand that the piercing studio and its employees are not liable for any adverse outcomes resulting from improper care or external factors outside of their control.

If I have any questions or concerns during the healing process, I will contact the studio for guidance or consult a healthcare professional if necessary.

Minor Consent (If Applicable)

I, the undersigned parent/legal guardian of the minor named above, give permission for them to receive the specified body piercing. I understand the risks involved and accept full responsibility for their care and aftercare.

MINOR FULL NAME

MINOR AGE

MINOR DATE OF BIRTH

PARENT/ GUARDIAN FULL NAME:

PARENT/GUARDIAN

Mother

Father

BIRTH CERTIFICATE

Consent and Agreement

I, the undersigned, consent to the body piercing procedure described above and understand the following:

Body piercing involves puncturing the skin, which carries potential risks such as infection, allergic reactions, and scarring.
Aftercare instructions will be provided, and it is my responsibility to follow them to ensure proper healing.
The healing time varies depending on the type of piercing and individual factors.
The piercer and studio are not responsible for any complications arising from failure to follow aftercare instructions.

FULL NAME

Signature

Date