Date of Birth (DD/MM/YYYY)*
I give consent to Sian to carry out my piercing
Haemorrhaging / bruise easily?*
HIV / HEP A B C D etc?*
High blood pressure?*
Reaction to skin care products/moisturisers/soap/creams?*
Slept well in the last 24 hours?*
Are you pregnant?*
Have you taken any blood thinning medication?*
Are you prone to fainting or dizziness?*
Have you taken any drugs or consumed alcohol in the past 24 hours?*
If you are under the age of 18, you will need parental consent to continue with the piercing. Please gain consent from your parents and get them to put their signature in the box below.
I give my child permission to receive a piercing
I have read and agreed to the terms of service
Apologies, we cannot tattoo anyone who has HIV. Please return to the homepage.