Standard Consent Form
(If you are considering a piercing and are under 18 years of age, go to the "Parental Consent Form" and have your parents fill it out and sign it.)
Body piercing is a form of surgery. At the Sydney Medical Body-Piercing Clinic (the Clinic) it is carried out
- by a registered medical practitioner
- using sterile equipment.
We strive to minimise the risk of complications but inevitably problems will occur for some persons. It is unpredictable who will develop complications.
Body-piercing creates breaks in the skin and mucous membranes which can admit viral and bacterial infections. In order to minimise the risk of transmission of disease care should be taken to prevent contact of piercings with other people's bodily fluids.
The risks of being piercing and owning a piercing include, but are not limited to:
- Allergy
- Bacterial infection. This is the commonest complication. Following the written aftercare instructions handed to every patient helps reduce this risk.
- Bleeding
- Hepatitis
- Keloids
- Migration & Rejection of the jewellery
- Nerve damage
- Scarring
- Viral infection
I (Name) _____________________________________ ,
Date of Birth: ____ _____ _____
request Sydney Medical Body-Piercing Clinic to pierce my
(body part/s) _______________________________ .
I acknowledge that I have read this document and indemnify the Clinic
against any damages arising from this procedure.
Signed: ________________________
Dated: ___ ___ ______
Revised 3 February 2003
Copyright © 1999-2003 Sydney Medical Body Piercing Clinic