In consideration of the warranty hereby given by the supplier Art Eternal that the quality of all implements and materials to be administered in the supply service, comply with all relevant statutory requirements,Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full Name *Date of Birth *Address * Parent/Guardian a must Telephone *Please tick if you have suffered from any of the following *Heart Disease / ConditionEczemaImpetigoHaemorrhagingSeizure e.g. EpilepsyDiabetesDermatitisAnxietyScar tissue in areaHepatitis A, B&CAcnePsoriasisCellulitisBulimiaHIV InfectionNausea/VomitingLow blood pressureFainting/DizzinessAllergic reactions: anaesthetics, adhesive plasters and jewellery/metalsGenital warts; if relevant to requested piercingNone of the aboveIF YOU ANSWERED YES TO ANY OF THE ABOVE, YOU SHOULD CONSULT A GP BEFORE PROCEEDING. Any other known medical conditions not listed that may affect the piercing procedure? *Any known allergies (including Latex allergy)? *Description of piercing *If under 16, a parent or guardian must countersign this form *CountersignedN/AParent/Guardian name (if applicable)I hereby certify that *I agree with the terms listed belowYour piercing will be carried out with pre-sterilised Titanium, which complies with safety standards in a clean and sterile environment, but you must note the importance of keeping a new piercing 100% clean until completely healed. Do you agree to take precautions, adhere to the aftercare instructions given? I agree that once I have been pierced, it is my sole responsibility and I will follow the advice given, as I understand that a piercing is susceptible to infection until healed. I understand that not all persons can be pierced and that some piercings may grow out. I also understand that if I remove the piercing at some later date some scarring may occur. I hereby confirm that the information given by me is true to the best of my knowledge and that I have requested this piercing of my own freewill.Submit Tattoo Disclaimer Piercing Disclaimer Aftercare Info Call US
