All questions about the body piercing procedure have been answered to my satisfaction and I have been given written aftercare instructions for the body piercing I am about to receive.*

I have been informed about what I can expect following the body piercing listed on the informed body piercing consent form, including medical complications that may occur following the body piercing.*

I understand the 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.*

I am the person on the ID presented as proof that I am at least 18 years of age, or the piercing will be performed in the presence of my parent or legal guardian.*

I am not under the influence of alcohol or drugs and I am voluntarily submitting to the body piercing without coercion. *

I understand there is a possibility to an allergic reaction to the jewelry inserted into the fresh body piercing.*

I understand there is a possibility of getting an infection, and I have been advised of the signs and the symptoms of an infection that indicate a need to seek medical attention. *

I agree to follow all instructions concerning the care of my body piercing.*

I understand there is a chance I might feel lightheaded or dizzy during or after being pierced and I agree to let my piercer know before, during or after the procedure.*