Piercing Consultation/Consent Form | Beauty Forms Portal

Piercing Consultation and Consent Form

Client Details

Full Name: *

Are you 18 or over? *

It is illegal to pierce anyone under age 18 without the consent of the minor's parent, guardian or custodian.

Date of Birth: *

Contact Number: *

Email: *

Please upload a clear image of proof-of-age documentation: *

Medical History

Are you currently taking any medications? *

Please list: *

Do you have any allergies? *

Please list: *

Are you currently (or trying to become) pregnant, or nursing? *

Do you have any of the following conditions? Please check all that apply.

Are you taking any blood-thinning medication (e.g. Warfarin, Apixaban etc.)? *

Have you recently been unwell? *

Which of the following were you unwell with? *

Please provide more detail: *

Emergency Contact Details

Emergency Contact Name: *

Emergency Contact Phone: *

Emergency Contact Relationship: *

Consultation

Body part(s) to be pierced: *

Aftercare

Cleaning Instructions

Clean your piercing until it is fully healed, which can take several months depending on your piercing and your own body.
Apply sterile saline to non-woven sterile gauze, and use it as a gentle compress for 5 minutes morning and evening - Do this no more than twice a day.
Moisture can cause irritation. Dry well afterward using a clean paper towel or using the cold setting on a hairdryer.

Aftercare Precautions

Be careful not to aggravate your new piercing. This includes washing and styling your hair, putting on or removing clothing, and sleeping on your fresh piercing.
When you shower, make sure all soaps or shampoos are clear of the area.
Expect build-up of dried matter on the piercing, use warm water on a paper towel (or a warm, gentle shower setting) to reduce the matter.
Be careful when doing any strenuous exercise when healing a fresh body piercing, and we suggest avoiding wearing tight clothing.
Do not remove your jewelry during its healing time as it will begin to close immediately.
We suggest you avoid swimming in chlorinated pool water or freshwater lakes during the healing process. If you have any questions or concerns, please contact us or your physician.

Aftercare Tips

Do not turn or rotate your jewelry.
Wash your hands thoroughly when cleaning your piercing. A piercing is an open wound, so dirty hands or fingernails can transfer bacteria.
Do not clean your piercing with chemicals such as alcohol, Neosporin, or bactine as these products are not designed for piercings.
Do not pull or pick the dried matter as it is attached to the healing tissue.
Try to avoid sleeping on the piercing - Use a travel pillow to suspend ear in the middle of the hole while you sleep.

Piercing Healing Times

Ear Piercings

Lobe - 2-4 months
Low Helix - 4-6 months
Helix 6-12 months
Tash Rook 6-12 months
Forward Helix 6-12 months
Daith 9-12 months
Conch 6-12 months
Tragus 6-12 months
Antitragus 9-12 months
Industrial 9-12 months

Facial and Nose Piercings

Nostril 6-12 months
Septum 4-6 months
Lip/Oral 4-6 months

Body

Navel 9-12 months
Nipple 9-12 months
Dermal 4-6 months
Genital 4-6 months

Stages of a healing piercing
To better understand the stages of piercing, we have provided an overview.

Just Pierced - At the beginning of your healing, your piercing will feel tender and will appear swollen. You may experience occasional discomfort which is normal. Be extra cautious during this stage of the healing process.

Healing - Once the initial discomfort has settled, your piercing will begin the full phase of healing. Piercings heal from the inside out which is why it takes some time to heal and requires extra patience. Please refer to the guide above to understand the average length of the healing process for your new piercing.

During this phase, you should still be careful with your piercing and continue your aftercare. You may still experience occasional discharge and tenderness.

Healed - A piercing is safely considered healed once you have passed the length of your healing time, the discharge you’ve been cleaning off for several months completely ends and the jewelry feels natural without any discomfort.

Aftercare tips by piercing location

Lobes and Helix

Avoid makeup and hair products.
Use a travel pillow to suspend ear in the middle of the hole while you sleep.
Use gentle pressure from showerhead to help clear debris.

Navel

Avoid tight clothing/waistbands resting on the piercing.
Showering is preferable to bathing for the first few weeks.
Avoid body creams, moisturizers and perfumes directly on piercing.
Ensure clothing does not rub on piercing. Ex. high waisted pants or jeans.

Advanced Ear Piercings

Tash Rook, Forward Helix, Daith, Conch, Tragus, Antitragus, Industrial, Orbital

Avoid headphones if they put any pressure on the piercing.
Avoid makeup and hair products.
Use a travel pillow to sleep.
Use the showerhead to help clear debris.

Nipple

No moisturizers, body creams directly on piercing.
Avoid exposure to other bodily fluids.
Ensure clothing that is in contact with the piercing is clean.
Avoid tight clothing, lace bras, and woven fabrics.

Nostril

Avoid any harsh face wash.
Avoid makeups, creams, and serums directly on the piercing.
If you have a cold or allergies, be gentle when blowing your nose.

Dermal/Surface

No moisturizers, body creams or perfumes.
Avoid exposure to other bodily fluids.
Be mindful of straps and handles on bags.
Do not wear jewelry that sits over the piercing.

Septum

Avoid any nasal sprays that aren’t saline.
Do not rotate the jewelry. Use warm water on a clean paper towel to remove buildup.

Genital

No creams or lubricants.
No heavy play.

Lip/Oral

Be mindful of spicy foods, acidic fruits, and alcohol.
Avoid makeups and creams directly on piercing.

Please tick the box to confirm: *

I have read and understood the aftercare advice provided to me on this form.

Consent

I acknowledge by signing this Release I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing, and all my questions have been answered to my full and total satisfaction. I acknowledge I have been advised of the matters set forth below and I agree as follows:

I have advised the Piercer of any allergies to metals, latex gloves, soaps and medications. I acknowledge it is not reasonably possible for the Piercer to determine whether I might have an allergic reaction to the piercing or processes involved in the piercing and further acknowledge that such a reaction is possible.
I acknowledge that obtaining this piercing is my choice alone and will result in a permanent change to my appearance and that no representation has been made to me as to the ability to later restore the skin involved in this piercing to its pre-piercing condition.
I acknowledge infection is always possible as a result of obtaining a piercing. I have received aftercare instructions and I agree to follow all of them while my piercing is healing.
I understand I will be pierced using appropriate instruments and sterilization.
I understand that any healing time advised is approximate and that it is different for each individual.
I agree to release and forever discharge and hold harmless the Piercer and all employees from any and all claims, damages or legal actions arising from or connected in any way with my piercing or the procedure and conduct used in my piercing.
I have trustfully represented to the Piercer I am over the age of 18 years.
I am not under the influence of drugs or alcohol.
To my knowledge I do not have any 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 done at this time.

Signature: *

Tap or click on the signature above to sign