Skin Radiance

Piercing intake

Consent to Pierce

Complete this on your phone while you wait. Your information is confidential and visible only to Skin Radiance staff.

Client information

Government photo ID

Upload a clear photo of your government-issued photo ID. If you are a minor, upload the parent or guardian’s government photo ID. Staff will verify the original in person. Large phone photos are automatically resized before upload.

Medical questionnaire

Answer every question. A “yes” answer does not automatically prevent a piercing; it lets your piercer review the information with you.

Are you currently pregnant or breastfeeding?
Have you ever had a herpes infection at a proposed piercing site?
Do you have a history of diabetes, cardiac valve disease, hemophilia or other bleeding disorders, or allergic reactions to latex, antibiotics, metals, or antiseptics?
Are you currently taking, or have you taken in the last 8 weeks, medication including antibiotics, Accutane, blood thinners, prescribed medicines, or over-the-counter medicines?
Do you have a history of keloid or hypertrophic scarring; psoriasis or eczema at or around the piercing site; or any open wounds?
Are there any other factors that may put the body artist at risk for blood-borne pathogen exposure?
Are you under the influence of any drugs or alcohol?
To your knowledge, do you have any physical, mental, or medical impairment or disability that may affect your wellbeing as a result of getting a piercing today?

Consent to Pierce and Release of Claims

I have had the opportunity to ask questions about my piercing(s). I understand that a piercing is a procedure performed with a needle to create an opening in the skin and insert jewelry, and that body piercing may be permanent or may not close after jewelry is removed.

I understand that known and unknown risks include infection, allergic reaction, migration, swelling, redness, piercing bumps, keloids, bleeding, tenderness, bruising, and the need for medical care. I will tell my piercer about relevant health information and follow the aftercare instructions provided.

I understand recommended aftercare includes avoiding touching, twisting, turning, or picking at the site; using only the recommended solution; sleeping on clean bedding and not on the piercing; cleaning as directed; avoiding oral contact, rough play, and bodily-fluid contact near the site until healed; and avoiding submersion in oceans, lakes, hot tubs, and other unhygienic water for the full healing period (at least six weeks and longer if not healed). I will seek medical care for severe redness, swelling, pain, foul or colored discharge, or red streaking.

I understand that photos may be taken for insurance and marketing purposes and that Skin Radiance staff must review this form, confirm my identity, anatomy, fit, material, availability, and final placement before the procedure. I release Skin Radiance and its agents or students from liability before, during, or after the appointment to the extent permitted by law.

Please do not submit this form on public Wi‑Fi if you prefer to complete it with staff instead.