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Emerald and Opal Piercing Studio Consent Form

Client Agreement

This agreement is between the client and Emerald and Opal Piercing Studio's body piercer, confirming that full communication has occurred to ensure a legal, safe, and successful body piercing procedure.

Client Information

Birthday
Month
Day
Year

Consent for Minors (if applicable)

Are you the parent or legal guardian of the minor?
Yes
No

Health and Safety Screening

I am 18 years of age or older (or have parental consent)
Yes
No
Have you eaten within the last 2 hours?
Yes
No
Do you have any allergies we should be aware of (latex, iodine, stainless steel, titanium, or other products)?
Yes
No
Have you taken any blood thinners, such as aspirin or ibuprofen, or consumed alcohol within the past 24 hours? Please note that this may increase the risk of bleeding during the piercing process.
Yes
No
Do you have any conditions that might affect the piercing procedure or healing process?
Yes
No
Are you prone to fainting?
Yes
No
Are you pregnant?
Yes
No

Jewelry and Responsibility Acknowledgment

I acknowledge that the piercer is not responsible for any adverse reactions my body may have to the metal used in the piercing jewelry.

I understand that I am solely responsible for the aftercare and upkeep of my piercing.

I understand that getting a body piercing involves risks, including fainting, vomiting, and infection.

Statement of Consent

*I authorize Emerald and Opal Piercing to complete my requested piercing. I hereby release Emerald and Opal Piercing from all liabilities, claims, actions, or demands in law or equity that I or my heirs may have now or in the future due to complying with my request to be pierced.


I confirm that I have provided accurate and complete information regarding any medical conditions that could affect the outcome of this procedure. These include, but are not limited to: allergies (e.g., to iodine, latex, or metals), diabetes, anemia, hemophilia, high or low blood pressure, heart disease, swelling, rashes, lumps, or discoloration in the area to be pierced, immunosuppressive disorders, or any condition requiring antibiotics before medical procedures.


Additionally, I have disclosed all medications I am currently taking, as well as any piercings, tattoos, surgeries, serious illnesses, or injuries I have experienced within the past 90 days.


I certify I am not pregnant or nursing.


To promote proper healing of my piercing, I agree to follow the written aftercare guidelines provided until the healing process is fully complete. Depending on the piercing, I understand that healing may take 6 weeks to 9 months or longer.


I acknowledge that Emerald and Opal Piercing Studio employees or agents provide aftercare instructions based on their professional experience and current industry standards.


I understand that Emerald and Opal Piercing employees and agents are not medical professionals; their written, verbal, stated, or implied advice is not a substitute for medical guidance. In the event of a serious medical concern, I will consult my physician.


By signing this release, I declare under penalty of perjury that the information I have provided is accurate and truthful.

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