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Consent form

Personal Information

Legal First Name

Legal Last Name

Preferred Name & Preferred Pronouns

Date of Birth * required

Email Address

Phone

Street Address

Street Address Line 2

City

Postal / Zip code

Country

Emergency Contact Information

First and surname of emergency contact

Emergency contact number

Relationship *

Parent

Friend

Partner

Relative

Today's date * required

What piercing are you having done today?

All information provided in this consent form is used to validate your ability to get pierced to our insurance company and nothing is shared outside of those purposes in accordance to GDPR regulations to protect both client and service provider.

Medical Information

Please check all that apply to the client:

Covid-19 or other flu-like symptoms

High or low blood pressure (may cause diziness or fainting)

Allergy to nickel or latex (our jewellery is nickel free and we can wear latex free gloves during the piercing at request)

Haemophilia or other blood disorders (may result in more bleeding and bruising during piercing and healing)

Diabetes (can reduce healing properties in the skin)

Epilepsy or other conditions that can cause seizures

Heart conditions

Auto-immune disease or treatment causing it i.e chemotherapy

Hepatitis/HIV

Pregnant or nursing

Prone to bleeding, bruising, fainting, scarring

Please list any medications you take below:

I confirm the following statements are true: * Required

I am not under the influence of alcohol or recreational substances of any kind

I am not aware of any reason I should not be getting pierced today

I have had something substantial to eat

I am aware of potential risks and complications involved with piercing and I have done adequate research before making my decision

I am aware that piercings can migrate and reject with improper care

I release all rights to any photogaphs and videos taken of me and the piercing and give consent in advance for their representation in print or electronic form, as well as use for promotional content for Anatomy Arts or the practitioner (if you don't agree with this statement please let your practitioner know NOT to take photographs or videos of your piercing

I understand I have been given adequate opportunity to read and understand this consent form, that has been given to me in a timely manner allowing me to calmly read through it, and I understand I am signing a legal contract waivering certain rights

I commit to following the aftercare provided by my piercer and Anatomy Arts only

I will ensure my jewellery is tightened when appropriate and that Anatomy Arts is not responsible for the loss of jewellery at any point

I hereby declare that I am of legal age and will provide valid proof of age in my consent form and I am competent to sign this agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding of this agreement

Please upload the clients ID

Upload File

Additional documentation

Upload File

Upload supported file (Max 15MB)

Your Signature

Parental Consent section (if applicable)

Parent/legal guardian first and surname

Parent/legal guardian's phone number

Relationship to minor

Has the parent/legal guardian correctly input the minors details?

Yes

No

Does the minor client consent to the piercing to be made today?

Yes

No

Do all parents/legal guardians consent to the piercing to be made today?

Yes

No

Please upload parent/legal guardian ID (if client is 17 or under)

Upload File

Thanks for submitting!

Contact us

Please email us if you have any enquiries and we will aim to get back to you as soon as possible.

Thank you - Dawn and Marcello.

Anatomy Arts,

17a Wedgwood Road,

Bicester,

OX26 4UL.

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