Consent Form – Piercing

I acknowledge by signing this release I have been given the full opportunity to ask all questions which I might have about obtaining a piercing from 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:

1. I am not pregnant or nursing. I do not have epilepsy or hemophilia. I do not suffer from any heart conditions or take medication which thins the blood. I have informed my piercer of any condition such as diabetes that might hamper healing of the piercing.
2. If I suffer from hepatitis, or any other communicable disease, I have informed the Piercer of this fact and I have been advised of any procedures necessary to promote the satisfactory healing of my piercing.
3. I do not suffer from medical or skin conditions such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the piercing or any open wounds or lesions at the site of the piercing.
4. 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.
5. 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.
6. 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.
7. I acknowledge infection is always possible because of obtaining a piercing. I have received aftercare instructions and I agree to follow all of them while my piercing is healing.
8. I understand I will be pierced using appropriate instruments and sterilization.

AFTERCARE:

Cleaning Solutions

• Packaged sterile saline (with no additives, read the label) is a gentle choice for piercing aftercare. If sterile saline is not available in your region a sea salt solution mixture can be a viable alternative.Dissolve 1/8 to 1/4 teaspoon (.75 to 1.42 grams) of non-iodized (iodine-free) sea salt into one cup (8 oz / 250 ml) of warm distilled or bottled water. A stronger mixture is not better; a saline solution that is too strong can irritate the piercing.

Cleaning Instructions for Body Piercings

• WASH your hands thoroughly prior to cleaning or touching your piercing for any reason.
• SALINE rinse as needed during healing. For certain placements it may be easier to apply using clean gauze saturated with saline solution. A brief rinse afterward will remove any residue.
• If your piercer suggests using soap, gently lather around the piercing and rinse as needed. Avoid using harsh soaps, or soaps with dyes, fragrances, or triclosan.
• RINSE thoroughly to remove all traces of the soap from the piercing. It is not necessary to rotate the jewelry through the piercing.
• DRY by gently patting with clean, disposable paper products because cloth towels can harbor bacteria and snag on jewelry, causing injury.

What To Do:

• Wash your hands prior to touching the piercing; leave it alone except when cleaning. During healing, it is not necessary to rotate your jewelry.
  • Stay healthy; the healthier your lifestyle, the easier it will be for your piercing to heal. Get enough sleep and eat a nutritious diet. Exercise during healing is fine; listen to your body.
  • Make sure your bedding is washed and changed regularly. Wear clean, comfortable, breathable clothing that protects your piercing while you are sleeping.
  • Showers tend to be safer than taking baths, as bathtubs can harbor bacteria. If you bathe in a tub, clean it well before each use and rinse off your piercing when you get out.

What To Avoid:

• Avoid moving jewelry in an unhealed piercing or picking away dried discharge with your fingers.
  • Avoid cleaning with Betadine®, Hibiciens®, alcohol, hydrogen peroxide, Dial® or other soaps containing triclosan, as these can damage cells.
  • Avoid ointments as they prevent necessary air circulation.
  • Avoid Bactine®, pierced ear care solutions and other products containing Benzalkonium Chloride (BZK). These can be irritating and are not intended for long term wound care.
  • Avoid over-cleaning. This can delay your healing and irritate your piercing.
  • Avoid undue trauma such as friction from clothing, excessive motion of the area, playing with the jewelry, and vigorous cleaning. These activities can cause the formation of unsightly and uncomfortable scar tissue, migration, prolonged healing, and other complications.
  • Avoid all oral contact, rough play, and contact with others' bodily fluids on or near your piercing during healing.
  • Avoid stress and recreational drug use, including excessive caffeine, nicotine, and alcohol.
  • Avoid submerging the piercing in unhygienic bodies of water such as lakes, pools, hot tubs, etc. Or, protect your piercing using a waterproof wound-sealant bandage. These are available at most drugstores.
  • Avoid all beauty and personal care products on or around the piercing including cosmetics, lotions, and sprays, etc.
  • Don't hang charms or any object from your jewelry until the piercing is fully healed.

Therefore, I request the Piercer to pierce my ear/nose. I agree to release and forever discharge and hold harmless the Piercer and all employees from 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 or the procedure and conduct used in my piercing.