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Piercing application form Navel

APPLICATION PIERCING


APPLICATION MUST BE COMPLETED IN FULL
and hereby acknowledge that I have been given full opportunity to ask any all questions which I might have about obtaining a tattoo from "INDUSTRIAL ART" and that all my questions have been answered to my full and total satisfaction

MEDICAL HEALTH HISTORY

(Please read first, then initial before each sentence)

I do not have diabetes.
I am not pregnant or nursing.
I do not have epilepsy or hemophilia
I do not have any allergies to metal, latex, soap, and/or medications
I do not suffer from any heart conditions or take any medication that thins my blood
I am not under the influence of alcohol or drugs
I do not have any physical, metal or medical impairment or disability, which might affect in a direct or indirect way my decision to have a tattoo done at this time

CONSENT, RELEASE AND WAIVER OF ALL CLAIMS

(Please read first, then initial after each sentence)

I specifically acknowledge the following:

Obtaining this tattoo is my choice alone and will result in a permanent change to my appearance, and that "NO" representation has been made to me as to the ability to later restore the skin involved in this tattoo to it is pre-tattoo condition.
It is not reasonably possible for the tattoo artist determine whether I might have an allergic reaction to the tattoo or processes involved in it and further acknowledge that such reaction is possible
Infection is always possible as a result of obtaining a tattoo
I realize that i have the alternative not to get this tattoo and therefore, I give consent to my tattoo artist named in section 1 to tattoo my
I understand this tattoo usually takes 2 weeks or longer to heal. I agree to release and forever discharge and hold harmless the tattoo artist, all employees and owners from any and all claims, damages or legal actions arising from or connected in any way with my tattoo or procedure and conduct used in the same

RECOMMENDED CARE OF NEW PIERCING

Navel and Nipples: (Estimated healing time: 6 to 9 months)

Wash your hands thoroughly, and then clean your new piercing twice a day with PROVON medicated antibacterial soap.
First remove any matter that may have dried on the jewelry and around the opening of the piercing with warm water and a cotton swab. Pour a little Provon on your hands, lather it up and then apply it to the jewelry/Piercing. Rotate the jewelry back and forth about 5 times to work the solution to the inside. Leave Provon in contact with the skin for 2 to 3 minutes. Finally, rinse the Provon off very thoroughly under running water while again rotating the jewelry back and forth about 5 times.
Extreme pain, large amount of pus discharge and discoloration of skin are some signs and symptoms of infection, if those occur, please consult with a physician.

WHAT TO AVOID WHILE A PIERCING IS HEALING

Avoid over cleaning or using too many cleaning/healing agents at once. (No Ointments)
Avoid tight clothing such as jeans, stockings etc. around the piercing.
Avoid submerging your piercing in water such as pools, Jacuzzis, etc.
Avoid any exercises that put any unnecessary pressure on the piercing.
Avoid touching the piercing except during cleanings.
Avoid sleeping on your piercing while it’s healing.

After reading and understanding the above aftercare instructions, I agree to follow all instructions concerning the care of my piercing while it is healing.

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