Piercing Consent

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Piercing Consent

Piercing Consent

הסכמה לפירסינג

הסכמה לקעקוע

Piercing Consent

Please fill up this form of consent

Name

Last Name

ID Number

Phone

Are you at list 18 years of age?

Yes No

Have you eaten in the last 4 hours?

Yes No

Have you drank any alcohol or consumed any drugs in the last 8 hours?

Yes No

Do you have any allergies that might impact the procedure/healing process of the piercing?

Yes No

Do you take any medication that might impact the procedure/healing process of the piercing?

Yes No

Are you pregnant or breast-feeding?

Yes No

Do you have one or more of the next diseases/viruses/conditions? If so - mark the ones that are true to you:

HIV Hepatitis SARS (Covid-19 and similar viruses) Diabetes Keloid scarring Epilepsy Heart disease Psoriasis Blood clotting disorder any other condition that might impact the procedure/healing process

I agree the Terms & Conditions

Sgnature

opening hours

sunday – Thursday: 12:00-20:00

Friday – 12:00-16:00

Sturday – Closed

Yedidya Frenkel 37 Tel Aviv

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