*FILL THIS OUT ONLY THE DAY OF YOUR APPOINTMENT -New Flower Studio Consent Agreement

This form is based on suggested guidelines from the Association of Professional Piercers.

Do not fill this out until the day of your appointment. If you fill it out before that date you will be required to submit a new form. Please schedule your appointment first. This form needs to be completed each time you enter the studio while we're still following our COVID19 protocols.

New Flower Body Piercing is committed to protecting you, our other clients, and our staff. As long as COVID-19 remains a threat we'll be operating our studio accordingly. Completing this document is required to be admitted into our studio and will remain confidential. This form does not need to be printed.

Please enter today's date. *

YYYY

Please type your first and last name, date of birth, and phone number below to confirm you agree to the current New Flower Studio operating procedures. *

New Flower's current COVID19 policies are for the safety of everyone, including other clients and the staff. Many of them are required by the state and the city. I understand that I will be asked to leave if I refuse to comply with safety protocols established by the studio. *

I will comply with all safety protocols

I understand that New Flower's staff is not offering sales or services to anyone under 18, not offering sales or services for the mouth or nose, and only allowing one visitor in the studio at a time. *

I understand

COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. I understand being inside any business increases my risk of contracting and spreading COVID-19. No business can completely eliminate the risk of infection. *

I understand

I confirm that I do not display any of the symptoms of COVID-19 including dry cough, runny nose, sore throat, shortness of breath, loss of sense of taste or smell, or fever. *

I confirm

I confirm that I have not been in close contact with anyone who has been diagnosed with COVID-19 in the past 14 days. *

I confirm

We're required to have a government ID on record. We will examine this at the time of your piercing. We only accept the identification cards listed below. Please indicate which ID you'll bring with you. We do not accept school IDs. There will be no exceptions. *

Driver's license (any state or country)

State or country ID (any state or country)

Passport (any country)

Military ID

I understand piercings do not cure or offer pain relief for any condition. *

I understand there are no health benefits to body piercing

There will only be time for the services you sign up for when you scheduled your appointment. We have other clients to help and need to stay on time. The services I signed up for at New Flower Studio today are: (navel piercing, jewelry purchase, jewelry insertion, examination, troubleshooting etc...) *

I understand that the availability of any service depends on my anatomy, the available jewelry, and whether or not this is a service the piercer offers. *

I understand

I understand that a piercing is created with a needle or similar device used to create a channel in the body for the purpose of installing jewelry. Answer if you're receiving a new piercing.

I understand

Clear selection

I am not under the influence of drugs or alcohol that may influence my decision. *

I am not

I understand I may ask questions at anytime before, during, or after this service or procedure. *

I understand

If I consent to having pictures taken of my piercing or procedure they may be used by New Flower Studio and their associates for promotional purposes. *

I understand

I understand that piercings are semi-permanent and may heal slowly, scar, migrate, reject, bleed, swell, become inflamed, infected, and need medical attention. I understand I will be given written and verbal aftercare suggestions which are also available at newflowerstudio.com/aftercare. *

I understand

*Critical. I understand if I take antibiotics before seeing a dentist or for other similar services I may need to do the same before my piercing. Answer if you're receiving a new piercing.

I do not take antibiotics before seeing the dentist because of a serious health condition.

Clear selection

I release from liability and claims New Flower Inc and it’s associates. If I have concerns for my piercing I will visit New Flower Studio for advice. If I have other health issues I will visit a doctor. *

I release

How long has it been since you've eaten a meal? Answer if you're receiving a new piercing.

Less than 3 hours

3 hours or more

Clear selection

Have you consumed alcohol, caffeine, or other prescribed blood thinning products in the last 24 hours? Answer if you're receiving a new piercing today.

Yes

Clear selection

Answer only if receiving a new piercing today. Are you pregnant or nursing?

Yes

Clear selection

Have you ever fainted before? (for any reason) *

Yes

California requires us to record whether or not you have diabetes, hemophilia, heart conditions, allergies, immune disorders, epilepsy, skin conditions, or any other health concern that may interfere with the procedure or healing a new piercing? You may list them below. If you have no conditions please type "none." Answer only if you're receiving a new piercing today.

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