Your Information Contact Telephone Number * Age * How did you hear about us? Passing By Recommendation Been here before Google Maps Google Search Facebook Instagram Business Card / Flyer Poster Email / Mailshot Type of ID Not Applicable Passport Driving Licence(Photo) Other Valid Photo ID Which country do you reside in? * – Please select – United Kingdom of Great Britain and Northern Ireland United States of America Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Kingdom of) Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland (Republic of) Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia (Republic of) Northern Mariana Islands Norway Oman Pakistan Palau Palestine (State of) Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania (United Republic of) Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela (Bolivarian Republic of) Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Piercing and Appointment Information I understand that the potential risks of the procedure are: • Scarring, Blood Poisoning(Septicaemia) • Jewellery Embedding/Migration • Localised Infection, Allergic Reactions to Jewellery • Localised Swelling & Trauma • Tongue Piercing May lead to swelling, choking & restriction of the airway. Tooth/Gum Damage (if applicable) * I understand that healing times vary from person to person however general healing times can be as follows; earlobe, eyebrow, septum, lip, tongue & navel 4+ months; cartilage such as helix, Tragus, nose etc 6+ months; nipple 8-12+ months. * Piercer Name * Type and Location of Piercing * Date & Time of Appointment * I confirm that I do not currently suffer from or have a history of: *
Impetigo, Cellulitis, Eczema, Psoriasis, Heart disease/disorders, Haemophilia, Low or High blood pressure Epilepsy, Diabetes HIV, Hepatitis B/C
Conditions which compromise the immune system, Conditions that may cause haemorrhaging e.g leukaemia. Conditions which may cause excessive bleeding Allergies to metals(including Nickel), Latex, antiseptics, adhesive dressings or topical dressings and medicines. I am not under a course of medication. I am not pregnant or breast feeding. I am not under the influence of Alcohol, and or drugs. I have not taken Aspirin or other medicines that thin the blood. I am over 18 years of age or that my Parent/Guardian has signed this from. I agree to follow the procedures outlined in the written aftercare and understand that neglect to follow these procedures or poor hygiene could lead to improper healing of the tattoo and infection. I have checked and verified the spelling of any lettering included within my tattoo(if applicable). I do not suffer from any other condition through which my health may be compromised when receiving a Piercing. Your Consent to the Procedure I give my consent to the procedure *
I declare that I give my full consent to the Piercing procedure being carried out by the practitioner named above. I confirm that the potential complications, e.g infection and swelling for the procedure undertaken, and aftercare instructions have been explained to me. I understand that I must follow the instructions given on the written aftercare sheet. I confirm that the information provided by me on this consent form is correct to the best of my knowledge, that I am over the age of consent for this procedure(e.g 16 for non intimate piercings and 18 for intimate piercings, if under 16 for piercings parent/guardian must countersign this form) and that I am not under the influence of alcohol or drugs. I confirm that I have requested the procedure of my own free will. I hereby release Tattoo Events Ltd and the Piercer named above from all manner of liabilities, claims, actions and demands in law or in equity. I understand the Piercer named operates on a self employed basis within The Tattoo Society and this agreement is in force between you the client and the Piercer named. I understand The Tattoo Society will retain this form for Internal Record keeping and compliance purposes and that information on this form will be stored on computer.
Date / Time of Signature *