Body Piercing Consent Form Choose Your Piercing Medical Information Contact Information & Consent What's Next Company Please make sure you have your Appointment Date & Time to hand Email Address * I hereby declare that I give me full consent to Tribal Voice (Please select a store location) * Plymouth Torquay Please Be Aware - Choosing multiple piercing areas in close proximity that are prone to movement and swelling, may be refused and is not advised. This will effect your healing time. - We will confirm the number and type of piercings suitable for you, during your appointment. I understand that the quantity and location of my piercings will be confirmed on the day of my appointment. Piercing Agreement * Which piercing would you like? (Max. 3 per appointment) * Ear Piercing (Scaffold/Industrial or Top Orbital = 2 piercings) Facial Piercing (Incl. Nose & Septum) Oral Piercing Body Piercing (Incl. Genitals) By answering this question, you understand that the piercing will be carried out under hygienic conditions, using the appropriate sterile instruments (including pre-sterilised single-use needles), jewellery and techniques. Please state chosen piercing(s) * If you are unsure of the piercings name, state the approximate location(s) Medical Information We ask these questions for your saftey and so we can be aware of any potential problems during and after the piercing has been carried out. For exmple: people with low immune systems will take longer to heal - we can give a more tailored aftercare based on the info you give us. Do you suffer from any heart conditions or seizures eg: Epilepsy? * Yes No Do you suffer from Haemophilia? * Yes No Do you suffer from Haemorrhaging or bruise easily? * Yes No Do you suffer from immune-compromising conditions? * Yes No Do you suffer from High Blood Pressure? * Yes No Do you suffer from Diabetes? * Yes No Do you suffer from allergic responses to adhesive plasters, creams, metals, iodine, latex or wheatgerm? * Yes No Will you have taken blood thinning medication* eg: Aspirin in the last 24 hours before attending your appointment? * Yes No *A Doctor's Note may be required for ongoing medication I agree I am not suffering from any short term, contagious illnesses. This includes, but not limited to: colds, flu, covid-19, infections etc * I agree This is to protect you and our working staff Will you have taken any recreational drugs or consumed alcohol in the last 24 hours before attending your appointment? * Yes No *A Doctor's Note may be required for ongoing medication. Are you pregnant or a nursing mother? * Yes No Are you prone to fainting or dizziness? * Yes No Are you prone to swelling? * Yes No If you have swollen excessively in the past its good for us to know before we pierce you so we can accommodate the jewellery Will you have slept well in the last 24 hours before attending your appointment? * Yes No We do not advise attending an appointment after a Night-Shift, please organise your appointment accordingly. Do you agree to eat a full meal within 4 hours before attending your appointment? * I Agree DON'T FORGET! Please note we will not be able to accept this application unless you eat a full-meal within 4 hrs before your appointment. We hold the right to refuse on the day & you will loose your appointment slot. Contact Information & Consent By completing this section: - I confirm that all of the information provided to you in the Consent Form is correct to the best of my knowledge. - I confirm I am not under the influence of alcohol or drugs. - I confirm I have requested this body piercing of my own free will. First Name * Surname * Address * Postcode * Contact Number * Age * Date Of Birth * What's Next? - Please book an appointment with us online. Note: Before attending your appointment, you must have eaten a full meal within the last 4 hours, not taken any blood thinning medication (non-prescribed), recreational drugs or alcohol* - Jewellery will be shown on the day & piercing prices will also be confirmed on the day, as this may vary depending on the jewellery chosen. lease bare in mind the prices online are the MINIMUM you will pay. - Please notify us of any changes in circumstances or if you're running late, as soon as possible. - Any late/missed appointments without notifying us beforehand, will be removed and you will have to re-book. Please be aware, if you are running late and we are fully booked we will not be able to move your appointment. - Photo ID is required during your appointment, please make sure to bring this with you. If you arrive with a birth certificate and nothing else you will not be pierced and your deposit will not be refunded. - If Parental Consent is required, the parent/guardian must be present in-store during the appointment. - Parent/Guardian's must have their own Photo ID and a copy of the applicant's Birth Certificate (or other proof of guardianship) during the appointment* *We have the right to refuse anyone, under our own discretion, no matter the reason. Have you booked your appointment? * Yes No Only 1 appointment is needed for this application. Appointment Date Selected * Appointment Time Selected *