ConsentForm Fill out the consent form by choosing your booking type:Choose your Booking Type(Required) Tattoo Piercing Tattoo Consent FormFull Name(Required)Date of Birth(Required)Contact Number(Required)Address(Required)Area to be Tattooed(Required)Medical Conditions Eczema, Psoriasis, Acne, Cellulitis, Psoriasis or other skin condition - more prone to skin infections Heart Disorders - more prone to serious heart complications from any blood infections High/Low Blood Pressure - can cause light headedness Haemophilia and other bleeding disorders - may result in poor clotting/heating Epilepsy or other form of seizures - mdeication may casue side effects and may result in fitting during treatment Diabetes - can reduce healing properties of the skin resulting in infection Hepatitis - may pose a risk for operator Autoimmune Disease or treatment causing it e.g. cancer treatment - more prone to serious infection, HIV a risk for operator Allergies especially nickel allergy - may result in serious skin reactions present in products, i.e. ink, jewellery Pregnant - immune response affected by pregnancy and any infection may affect the unborn child Nursing Mother - risk of infection can be a risk to the baby Medication - side effects may affect healing and recovery from treatment Any other condition not listed - please give details below:Individual Consent(Required) I agree to the declaration below:I declare that I give my full consent to tattooing being carried out at Studio 16 and I am over the age of 18.Associated risk with a tattoo(Required) I agree to the risks noted below:Localised swelling and trauma around the site Scarring Blood poisoning (septicaemia) Localised infectionSignature(Required)Date(Required) MM slash DD slash YYYY Piercing Consent FormConsent(Required) I agree to the Piercing Consent below:• Please note appointments are ONE person in the piercing room ONLY • For intimate piercings (nipple) you MUST be 18 years old or above (we will ask for photographic ID) • We pierce ages 16+ without parental consent (we will ask for photographic ID. Please make sure you bring this to your appointment) • For anyone under 16, a parent or legal guardian MUST be present to sign the consent form or we cannot perform the piercing. These appointments are also ONE in the piercing room ONLY • Please remember: all piercing appointments are timed, therefore if you are late to your appointment we may not be able to perform all or any piercings. *If you do not bring photographic ID to your appointment we reserve the right to refuse service, regardless of your age. Full Name(Required)Date of Birth(Required)Contact Number(Required)Address(Required)Area to be Pierced(Required) Ears - Lobe Ears - Lobe x2 Ears - Helix Ears - Forward Helix Ears - Tragus Ears - Anti Tragus Ears - Daith Ears - Rook Ears - Snug Ears - Flat Ears - Shen Men Ears - Conch Ears - Industrial Body - Nipple Body - Nipple x2 Body - Bellybutton Body - Dermal (only available with Sandra) Face - Nose Face - Septum Face - Eyebrow Face - Bridge Face - Medusa Face - Labret Face - Ash Face - Vertical Labret Face - Jestrum Face - Smiley Face - Tongue Medical Conditions Eczema, Psoriasis, Acne, Cellulitis, Psoriasis or other skin condition - more prone to skin infections Heart Disorders - more prone to serious heart complications from any blood infections High/Low Blood Pressure - can cause light headedness Haemophilia and other bleeding disorders - may result in poor clotting/heating Epilepsy or other form of seizures - mdeication may casue side effects and may result in fitting during treatment Diabetes - can reduce healing properties of the skin resulting in infection Hepatitis - may pose a risk for operator Autoimmune Disease or treatment causing it e.g. cancer treatment - more prone to serious infection, HIV a risk for operator Allergies especially nickel allergy - may result in serious skin reactions present in products, i.e. ink, jewellery Pregnant - immune response affected by pregnancy and any infection may affect the unborn child Nursing Mother - risk of infection can be a risk to the baby Medication - side effects may affect healing and recovery from treatment Any other condition not listed - please give details below:Age Check(Required) I am 16+ I am under 16 Name of Parent(Required) First Last Parent Contact Number(Required)Signature of Parent(Required)Signature(Required)Date(Required) MM slash DD slash YYYY Studio 16 Tattoo and Piercing 1 Wellington streetBallymena, BT43 6AX
