Permanent Jewelry Consent Waiver

permanent jewelry is a process that involves the use of welding jewelry together while on your body. the procedure is generally painless and your safety is of upmost importance to bijou ltd co. this consent form is intended to inform you of the risks of the procedure and to obtain your informed consent for the procedure and release Bijou ltd co from any and all liability.

Contact Details

Full Name: Client or Guardian

Birthday

Phone number

Address

If under 18 years of age, check this box and enter minor's name here.

Full Name: Client if Minor

I understand that although rare, an allergic reaction to the jewelry can occur.

I understand that the welding procedure does have some risks; including but not limited to potentional allergic reations, irritation, discomfort, burns, and scarring.

I agree to the jewelry care instructions recommended by the technician.

I understand that although this jewelry is intended to be permanent, durable and long-lasting, the length of wear can vary depending on my physical activity and other factors.

I understand that there may be some instances where where i will be required to remove my jewelry, including but not limited to medical procedures like MRI and surgery. I understand that the jewelry can easily be removed with scissors and re-attached at a later date.

I give Bijou Ltd Co technicians permission to photograph my jewelry and procedure for their own marketing and promotional purposes.

by selecting submit below, I confirm I have completed the above form to the best of my knowledge. I understand the risks and potential side effects associated with the permanent jewelry procedure. if i am under the age of 18, a parent or guardian must sign.

Enter today's date

Thanks for submitting Bijou Ltd Co Liability Waiver!

Screenshot a copy of this page to show your technician at time of service.