Piercing Consent Form

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A piercing consent form protects the piercer from liability and ensures the client knows and accepts the risks associated with body or ear piercing. The client’s signature communicates that they have been informed of possible adverse effects, that they have received after-care instructions, and that they consent to having their body altered.

Piercing Consent Form

A piercing consent form protects the piercer from liability and ensures the client knows and accepts the risks associated with body or ear piercing. The client’s signature communicates that they have been informed of possible adverse effects, that they have received after-care instructions, and that they consent to having their body altered.

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Last updated September 18th, 2024

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A piercing consent form protects the piercer from liability and ensures the client knows and accepts the risks associated with body or ear piercing. The client’s signature communicates that they have been informed of possible adverse effects, that they have received after-care instructions, and that they consent to having their body altered.

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Pregnancy and Piercing

Body piercing consent forms should ensure that pregnant women inform the piercer of their pregnancy. Women are generally discouraged from having piercings during pregnancy, particularly on the belly button, nipples, or genitals, because the holes are less likely to heal and are more prone to infection.[1]

Required Information

Client Care

The piercing consent form should include language that ensures the client is comfortable and prepared. The consent form will generally state that the client:

  • Has had an opportunity to ask questions regarding the piercing.
  • Will be pierced with appropriate, sterile instruments.
  • Has received aftercare instructions to avoid infection and promote healing.

Statements regarding what the client can expect from the piercing and the risks involved are essential to obtaining proper consent. Both body piercing consent forms and ear piercing consent forms should include the risk of infection and the fact that the procedure will change the client’s appearance.

Medical Disclosure

It’s important to ensure the client knows they must inform the piercer of any allergies or conditions that may affect the piercing, its healing process, or the piercer’s safety.

Sample

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PIERCING CONSENT FORM

I acknowledge by signing this consent form I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing from [PIERCER NAME] (hereinafter known as the “Piercer”), 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. If I am pregnant or nursing or have any condition that might affect the healing of this piercing, I will inform my Piercer.

2. 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.

3. 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.

4. 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.

5. 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.

6. I understand that body piercing can result in nerve damage, bone and tooth loss, and that if I choose to remove my jewelry, permanent holes or scars may be left.

7. 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.

8. I understand that there is a chance I might feel lightheaded or dizzy during or after being pierced. I agree to immediately notify the body piercer in the event I feel lightheaded, dizzy, and/or faint before, during, or after the procedure.

9. I understand I will be pierced using appropriate instruments and sterilization.

Therefore, I request the Piercer to pierce my [PIERCING LOCATION]. I understand this type of piercing usually takes [HEALING TIME] or longer to heal. 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.

Client Signature: ____________________________ Date: [MM/DD/YYYY]
Print Name: [CLIENT NAME]
Address: [CLIENT ADDRESS]

Sources

  1. American Pregnancy Association – Piercing and Pregnancy: Safety & Health Risks