Piercing and Appointment Information
Impetigo, Cellulitis, Eczema, Psoriasis, Heart disease/disorders, Haemophilia, Low or High blood pressure Epilepsy, Diabetes HIV, Hepatitis B/C
Conditions which compromise the immune system,
Conditions that may cause haemorrhaging e.g leukaemia.
Conditions which may cause excessive bleeding Allergies to metals(including Nickel), Latex, antiseptics, adhesive dressings or topical dressings and medicines.
I am not under a course of medication.
I am not pregnant or breast feeding.
I am not under the influence of Alcohol, and or drugs. I have not taken Aspirin or other medicines that thin the blood.
I am over 18 years of age or that my Parent/Guardian has signed this from.
I agree to follow the procedures outlined in the written aftercare and understand that neglect to follow these procedures or poor hygiene could lead to improper healing of the tattoo and infection.
I have checked and verified the spelling of any lettering included within my tattoo(if applicable).
I do not suffer from any other condition through which my health may be compromised when receiving a Piercing.
Your Consent to the Procedure
I declare that I give my full consent to the Piercing procedure being carried out by the practitioner named above. I confirm that the potential complications, e.g infection and swelling for the procedure undertaken, and aftercare instructions have been explained to me. I understand that I must follow the instructions given on the written aftercare sheet. I confirm that the information provided by me on this consent form is correct to the best of my knowledge, that I am over the age of consent for this procedure(e.g 16 for non intimate piercings and 18 for intimate piercings, if under 16 for piercings parent/guardian must countersign this form) and that I am not under the influence of alcohol or drugs. I confirm that I have requested the procedure of my own free will. I hereby release Design 4 Life Tattoo Ltd and the Piercer named above from all manner of liabilities, claims, actions and demands in law or in equity. I understand the Piercer named operates on a self employed basis within Design 4 Life and this agreement is in force between you the client and the Piercer named. I understand Design 4 Life will retain this form for Internal Record keeping and compliance purposes and that information on this form will be stored on computer.