Piercing Consent & Medical Declaration Form
A piercing consent template — records the medical declaration, understanding of risks and healing, and a signature, before piercing.
Description
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
Email address

Date of birth
Which piercing(s) today?
Multi-Select
Please tick anything that applies
Multi-Select
Please give details of anything ticked, plus any medications
Long Answer
Not under the influence
Consent
Risks & healing
Consent
Aftercare
Consent
Honest & of age
Consent
Signature
Signature
No credit card
Unlimited forms
Unlimited results
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.
No credit card
Unlimited forms
Unlimited results







