Prior to my piercing:

•  I received verbal information about the following and discussed it with the piercer or the establishment operator:

1. A brief description of the piercing procedure;

2. Any precautions for me to take before the piercing;

3. A description of the risks and possible consequences of body piercing services;

4. Instructions for care and restrictions following the procedure;

5. Restrictions against piercings of minors(if applicable).

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• If the piercing client have diabetes, epilepsy, hepatitis, hemophilia, HIV/AIDS, or any other communicable disease, heart condition, or take medicine that thins the blood, I HAVE/WILL advise the piercer.

• If the piercing client is under the influence of drugs or alcohol, I HAVE/WILL advise the piercer.

• If the piercing client is pregnant, I HAVE/WILL advise the piercer

• If the piercing client has a medical/skin condition such as but is not limited to: acne, scarring eczema(keloid), psoriasis, freckles, moles, or sunburnt skin where the piercing is to be placed, I HAVE/WILL advise the piercer.

• If the piercing client has an infection, rash or outbreak ANYWHERE on their body, I HAVE/WILL advise the piercer.

• I understand any skin treatment, laser hair removal, plastic surgery or other skin altering procedures may result in an adverse change to the piercing the piercing client receives today.

• I acknowledge that a piercing is a SEMI-permanent change to the piercing client's outer body appearance and that no representations HAVE/WILL be made to later change or remove the piercing. To my own knowledge, I do NOT have a physical, mental, or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a piercing performed on the piercing client.

• I acknowledge I am at least 18 years old and I have truthfully informed the piercer that obtaining this piercing is by a choice between myself and the piercing client and our choice alone. I consent to the application of the piercing and to any action or conduct of the representatives and employees of Studio B that are reasonably necessary to perform the piercing properly. 

• I acknowledge by signing this form and going through the piercing process, myself and the piercing client wave the right to take legal action against Studio B as a company, the piercer performing the procedure, or any other employable entity hired by/through Studio B.

• I acknowledge that all of the information provided above was done so accurately and truthfully.