Piercing Consent Form

I confirm that the information I have provided in this consent form is true to the best of knowledge and that I am not under the influence of alcohol or drugs. I also confirm that I have requested this piercing of my own free will.

I understand that the piercing will be carried out under hygienic conditions using the appropriate sterile instruments including pre-sterilized single use needles, jewellery and techniques. I also understand that anaesthetic may not be used during this procedure.

I consent to audio and visual filming via CCTV for the duration of my stay at Red’s and for Red’s to use video and audio material for safety and security reasons.

I confirm that I am not taking any other medication or suffering from any illness, condition or allergy, which a reasonable person should be aware of that, may react adversely to or be aggravated by piercing. I understand that a new piercing is susceptible to infection until healed and that proper aftercare of the piercing site once I leave Red’s Tattoo Parlour Ltd. is my responsibility. I confirm that I have been given after care advice and a link to further information and it has been explained to me and that I understand it. I also confirm that I will follow the aftercare procedure until the healing process is complete. I understand that not withstanding the hygienic conditions and sterile instruments, jewellery and techniques used by Red’s Tattoo Parlour Ltd., there are associated risks with piercing which include – infection, scarring, allergic reactions, localised swelling, jewellery embedding and that the piercing may grow out. In giving this consent I release Red’s Tattoo Parlour Ltd. and its employees from all liabilities, actions and demands which I may have now or in the future for any loss or damage suffered whatsoever caused as a result of my piercing or in respect of personal injury caused, negligence and any failure on our part to follow the aftercare procedures.

Piercing Consent Form

Do You – Suffer from any heart conditions or seizures e.g. epilepsy?*
Do You – Suffer from haemophilia?*
Do You – Suffer from haemorrhaging/bruise easily?*
Do You – Suffer from immune compromising conditions?*
Do You – Suffer from diabetes?*
Do You – Suffer from allergic responses to adhesive plasters/creams/metals/iodine/latex?*
Have You – Taken blood thinning medication e.g. aspirin in the last 24 hours?*
Have You – Taken any recreational drugs/alcohol in the last 24 hours?*
Have You – Eaten in the last 4 hours?*
Have You – Slept well in the last 24 hours?*
Are You – Pregnant/a nursing mother?*
Are You – Prone to fainting/ dizziness?*
Name*
First Last
Email*
Address*
Street Address City ZIP / Postal Code Country
Date Of Birth*
DD slash MM slash YYYY
Age*
Please enter a number from 0 to 99.
ID Shown*
Signature*
Date*
DD slash MM slash YYYY
Aftercare & Promotions*
We would like to send you details of how to look after your tattoo or piercing via email along with any special promotions we may run from time to time. Please confirm if you are happy to receive emails from us by checking one of these boxs.
- Yes please
- No thank you
Aftercare ALLERGY*
I am aware that the Lavender Aftercare contains almond oil and nut allergens.
- I am aware
OFFICE USE ONLY*