Welcome to Paradise Montreal

Your Information

Full name

Date of birth

Phone number

Email

Desired piercing(s):

Medical Information

Pre-Procedure Questionnaire

	YES	NO
Are you pregnant or nursing?
Are you under the influence of drugs and/or alcohol?
Are you taking any prescription narcotics?
Do you suffer from heart conditions and/or blood-thinning disorders such as hemophilia?
Do you have epilepsy, diabetes or anemia?
Do you have allergies to metals, medications, etc?
Do you have a phobia of needles and/or blood?
Did you take blood thinning medications (ex: aspirin) in the last 24 hours?
Did you ever have a negative piercing experience in the past?
Do you have a tendency to faint?

If you selected YES to any of the previous questions, you commit to informing your piercer as such

I commit

Release of all claims

I have read and acknowledged the following statement

I have been given the opportunity to ask any and all questions which I might have about getting a piercing from Paradise Tattoo & Piercing, and they have been answered to my total satisfaction ;

I voluntarily agree to the piercing procedure and I am fully aware that it is a permanent change to my appearance. I understand that the skin can't be later restored to its pre-piercing condition ;

Paradise follows a safe and hygienic piercing procedure. However, I understand that getting a piercing, despite Paradise’s best efforts, is a procedure that carries some risks that are out of my piercers control. These risks include but are not limited to : metal sensitivity, allergic reaction, inflammation, scarring, infection, fainting and others ;

I understand that it is my responsibility to follow all aftercare instructions while my piercing is healing. Complete piercing aftercare instructions have been explained to me or a copy of the aftercare sheet has been given to me ;

I have truthfully represented to my piercer that I am :

- Over the age of 16 for general body piercings ;

- 18 or over for nipple piercings ;

If I am under 16, I have a parent and/or legal guardian with me for approval ;

I have attentively read this statement and I have truthfully answered to all questions of the waiver. Therefore, I authorize the piercer to pierce me and I waive any legal action related to my piercing against them as well as against any other Paradise's employee.

Signature

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