PIERCING CONSENT FORM

Piercing Consent Form

HYGIENE & SAFETY STANDARDS:

Viaticum Gallery guarantees that all equipment, gloves, needles and jewelry used for your piercing procedure is sterile, and that we follow satisfactory routines for decontamination and sterilization. We test our autoclaves regularly, and the studio is verified by the local health department. We guarantee that jewelry used for your fresh piercing fits the EUs directive criteria on nickel content in first-time-jewelry.

PIERCING *

LOCATION *

JEWELERY *

*Ask Your Piercer*

SIZE (MM / CM) *

*Ask Your Piercer*

CONSENT - A *

I hereby give persons representing Viaticum Gallery AS permission to perform the above stated procedure on named above. I understand that piercing is being performed under the recommended conditions, using equipment and techniques that comply with all the relevant statutory requirements and certified by the local environmental health office.

CONSENT - B *

I confirm that I have received written information regarding aftercare (bottom of the page) and agree to follow the aftercare procedures recommended by the studio and artist until the piercing is fully healed. I understand that local or general infection can and may occur due to unclean conditions outside of the studio. I understand that the piercing is a wound and would be subject to swelling, scarring and any other symptoms relating to skin trauma which is a natural by-product of being pierced. I understand that all forms of skin penetration result in a permanent change. If I become aware of any potential problem, I agree to contact the studio and/or my doctor immediately for advice. I agree to indemnify Viaticum Gallery AS against all claims or proceedings in respect of any personal injury or damage arising out of, or as a result of this piercing.

HEALTH CONDITIONS:

Please indicate below if you currently have or think you may have any of the following conditions that may affect the treatment:

Blood Disorder *

Yes

Blood disorders may increase the risk of excessive bleeding and affect healing during piercing.

Allergies *

Yes

Allergies may increase the risk of adverse reactions to piercing materials or aftercare products.

Infectious disease *

Yes

Certain infectious diseases may require additional precautions to ensure safe piercing.

Skin Disorder *

Yes

Skin disorders may affect healing and increase the risk of irritation or complications following piercing.

Keloids *

Yes

A tendency to form keloid scars may increase the risk of excessive scarring following piercing.

Isotretinoin *

Yes

Isotretinoin use may significantly delay healing and increase the risk of infection or scarring.

Fainting *

Yes

A history of fainting may increase the risk of syncope during piercing procedures.

Epilepsy *

Yes

Epilepsy may increase the risk of seizures during piercing procedures, particularly if the condition is not well controlled.

Pregnancy *

Yes

Piercing is not recommended during pregnancy due to increased medical risk and potential complications.

Diabetes *

Yes

Diabetes may affect circulation and wound healing, increasing the risk of infection and delayed recovery.

I have eaten *

Yes

Not eating before piercing may increase the risk of fainting and discomfort.

Drugs/Alcohol (24hrs prior) *

Yes

Use of drugs or alcohol within 24 hours prior to piercing may increase the risk of bleeding, fainting, and complications.

Any medication / condition that may be of concern *

Yes

Do you have bleeding disorders, heart disease, any other relevant health conditions or taking blood-thinning medication?

Mention Details *

CONSENT - C *

I confirm that I am of legal age and will provide ID if requested by the studio and I am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement. I confirm that I have had sufficient time to read and understood this form, and agree to be legally bound by it. I confirm that I have been informed about the possible risks of getting pierced. I do this of my own free will and hereby declare that I am not under the influence of alcohol, drugs, or medications that could impair my judgment.Viaticum Gallery AS reserve the right to refuse performing the procedure if there is concern with any of the stated details for the matter of health and hygiene.

FULL NAME *

EMAIL *

DATE OF BIRTH *

TODAY'S DATE *

Signature *

Clear

ID Provided *

Yes

ID / Passport Number (or Legal Guardian’s ID if applicable) *

Please enter your ID or passport number. If you are a legal guardian or parent, please enter your own.

Upload ID

Maximum file size: 20MB

Where did you hear about us? *

Facebook

Instagram

Google

TikTok

Friend

Other

Facebook: @ViaticumGallery
Instagram: @ViaticumGallery
TikTok: @viaticumtattoogallery

AFTERCARE:

At Viaticum Gallery, we pierce by the method of cannula needles only. All needles are sterile single use medical grade and all equipment used is sterilised after every use by the regulated industry requirements. Aftercare advice will be given by your piercer at the time of the procedure and can be found on our website - Click Here. Please listen, read and follow to ensure the health and success of your piercing. We cannot be held liable for anything that happens after you leave the studio.

OUR FULL AFTERCARE GUIDE IS AVAILABLE WITH ALL THE DO'S AND DONT'S IS AVAILABLE ON OUR WEBSITE.

PLEASE READ, DOWNLOAD, SCREENSHOT, MEMORISE. A HAPPY PIECING IS ALL IN THE AFTERCARE!!! IN A NUTSHELL THOUGH:

Keep the area clean. A piercing is a wound and must be treated accordingly.
Do not touch, twist, or remove the jewelry unless instructed by your piercer. Scabbing is normal—do not pick.
Clean the piercing twice daily using sterile saline solution only, for a minimum of 6 weeks.
Do not use alcohol, antiseptics, TCP, chemical solutions, or harsh products.
Oral piercings should be cleaned after eating, drinking, or smoking.
Check that the jewelry is secure. With clean hands only, gently tighten threaded jewelry clockwise without touching the skin.
Healing varies from person to person. Do not rush the process. Swelling, redness, scabbing, discharge, or pressure bumps can be normal during healing.
If you are unsure whether symptoms are normal, contact us before taking action.

NOTE:

Retain this form for your reference and present it for any after care support you may require. Aftercare service within the healing period of 16 weeks will be free of charge or reduced on presentation of this form. Without the form, after the healing period, or any support required due to incorrect aftercare will be chargeable.
You can talk with one of us in private if you want.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

Price *

Artist *

Aftercare Product *

Yes

Supports proper healing and helps reduce the risk of irritation or infection.

Photos *

Yes

I consent to any pictures taken of me being used for promotion on Viaticum's website, social media, etc.

Are you interested in Viaticum giveaways, events , gifts? *

Yes

If you are human, leave this field blank.