COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

Pier(--Ninp- Consent Ind t Release Aoweement Today's Date: Procedure being performed noclav: Please read and initial each of the statements below: certify i am over the age of 18. 1 am the person on the legal IU presented as proof that I am at least 18 years of age. I understand that any effective removal of a body piercing may leave scarring. I have been informed of the nature, risks, and possible complications,and consequences of a piercing. understand the procedure carries with it known and unknown complications and consequences associated with this type of procedure, including but not limited to temporary minor bleeding bruising of skin surfaces, swelling, redness temporary discoloration, infection,and scarring 1 frilly understand this is a piercing process and therefore not an exact science,but an art. I request the piercing procedure/s and accept the possible complications and consequences of the said procedure/s. I certify that i am not under the influence of drugs or alcohol I am not pregnant or nursing and I consent to have the piercing procedure listed above performed today. The general nature of piercing as well as the specific procedure to be performed has been explained to me. I understand that there is a certain level of discomfort associated with the procedure and that each person has their own threshold level fo discomfort. 1 accept the responsibility of explaining to my technician my desire for specific positioning for any procedure done today I understand that after my service,there will be no refunds. No exceptions. I understand that my technician only utilizes sterilized disposable equipment to minimize the risk of infection or contamination and that my technician has received training inappropriate sanitation and hygiene techniques prior to performing any procedures. While the risk of infection from our procedures is extremely small, the possibility of such an occurrence cannot be totally prevented. Accordingly. I understand and accept the risk and release my technician and the business from any and all liability related to the subject procedure,except instances involving gross negligence. If have any signs or symptoms of infections I will seek medical care. Signs of infection include but are not limited to redness,swelling tenderness of the procedure site,a red streak going from the procedure site towards the heart, elevated temperature,or drainage from the procedure site. 1 grant permission to CHANGES BEAUTE LOUNGE to take and use:photographs and/or digital images of me for use in news releases, educational materials, and/or social media platforms including but not limited to Instagram, Facebook,Twitter,TikTok, YouTube and Pinterest. Weil-Deing as a direct or indirect result of my decision to have a piercing. If dispute arises out of or relates to this contract, or the alleged breach thereof, and it the dispute is not settled through negotiation the parties agree first to try in good faith to settle the dispute by mediation within 30 days before resorting to arbitration, litigation or some other dispute resolution procedure.