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OPIERCING CONSENT RELEASE FOR41 <br /> PLEASE READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND <br /> THE IMPLICATIONS OF SIGNING THIS DOCUMENT <br /> In consideration of receiving piercing from the practitioner <br /> (Name of Practitioner) <br /> located at <br /> (Name of Body Art Business) <br /> I confirm the following: <br /> All questions about the body piercing procedure have been answered to my satisfaction, and I have <br /> been given written aftercare instructions for the body piercing I am about to receive. <br /> I have been informed about at I cane following the body piercing listed on the informed body <br /> piercing consent form, including medical complications that may occur following this body piercing. <br /> I understand that body piercing can result in new damage, bone and tooth loss, and that if I choose <br /> to remove my jewelry, permanent holes or scars may be left. <br /> I am the person on the legal ID presented as proof that I am at least 18 years of age,or the body <br /> piercing will be performed in the presence of my parent or legal guardian. <br /> I am not under the influence of alcohol or drugs and that I am voluntarily submitting to body piercing <br /> without duress or coercion. <br /> I understand there is a possibility of an allergic reaction to the jewelry inserted into the fresh body <br /> piercing. <br /> I understand there is a possibility of getting an infection, and I have been advised of the signs and <br /> symptoms of infection that indicate a need to seek medical attention. <br /> I agree to follow all instructions concerning the care of my body piercing. <br /> I understand that there is a chance I might feel lightheaded or dizzy during or after being pierced. <br /> I agree to immediately notify the body piercer in the event I feel lightheaded, dizzy and/or faint before, <br /> during or after the procedure <br /> have been fully informed of the risks of body piercing <br /> including but not limited to infection and other medical complications, allergic reactions to metal jewelry, latex <br /> gloves, and antibiotics. Having been informed of the potential risks associated with receiving a body piercing, <br /> and I still wish top with the procedure. I assume any and all risks that may arise from the body <br /> piercing. <br /> Signature: Date: <br /> Procedure description: <br /> If single-use, presterilized equipment is used please, provide LoVID number. <br /> Artist: LoVID#: <br />