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Piercing Consent & Medical Declaration Form

A piercing consent template — records the medical declaration, understanding of risks and healing, and a signature, before piercing.

Description

A piercing breaks the skin, so it starts with informed consent and a medical declaration like any other skin treatment. This form captures both cleanly. It records the client’s details and date of birth, which piercings they’re having today, and a medical check covering the conditions that matter — diabetes, bleeding disorders, heart conditions, allergies to metals, keloid scarring and blood thinners. The confirmations keep the client informed and you protected. They confirm they’re not under the influence, that they understand piercings carry risks including infection and rejection and that healing takes time and care, that aftercare is their responsibility, and that they’re over 18 or have parental consent on file. A signature turns it into the dated record your licence and insurance expect. Have every client complete it before you pierce. It’s free, brand-styled, and makes the safety and legal foundation of your studio a quick, consistent step.

Form fields

Everything the Piercing Consent & Medical Declaration Form above collects — 11 fields, so you can see exactly what it captures before you make it your own.

Piercing Consent & Medical Declaration

  • Your name

    Name Icon
    Name
  • Email address

    Email Icon
    Email
  • Date of birth

  • Which piercing(s) today?

    Multi-Select Icon
    Multi-Select
  • Please tick anything that applies

    Multi-Select Icon
    Multi-Select
  • Please give details of anything ticked, plus any medications

    Long Answer Icon
    Long Answer
  • Not under the influence

    Consent Icon
    Consent
  • Risks & healing

    Consent Icon
    Consent
  • Aftercare

    Consent Icon
    Consent
  • Honest & of age

    Consent Icon
    Consent
  • Signature

    Signature Icon
    Signature
Use Template Arrow Right Icon

Template FAQs

Common questions about the Piercing Consent & Medical Declaration Form — what it captures, when to use it, and how to make it your own.

Why does piercing need a consent and medical form?

Because a piercing breaks the skin and carries real risks, so clients must understand and agree to them. A signed consent and medical declaration protects the client and meets licensing and insurance requirements.

What conditions does the medical check cover?

Diabetes, bleeding disorders, heart conditions, epilepsy, skin conditions at the site, metal and latex allergies, pregnancy, blood thinners and keloid scarring — the things that affect whether and how to pierce safely.

Why ask about keloid scarring and metal allergies?

Because keloid-prone skin can scar from piercings and nickel allergies are common, both of which affect suitability and jewellery choice. Flagging them lets you advise and choose materials appropriately.

Should it be completed every time?

Yes — a fresh consent and medical declaration before each piercing captures any changes in health and records consent for that specific piercing.

Why ask for date of birth and a signature?

To confirm age and record that the client actively agreed. Together they make the form a reliable, dated record rather than an unsigned questionnaire.

Is the form free?

Yes. It’s free with a Fun Forms account, fully brandable, and ready for clients to sign on a tablet before their appointment.