Laughing Buddha Insert, Removal, and Stretching Consent Form

Thank you for choosing Laughing Buddha for your procedure today. Please have your ID handy and complete the following form. For security, the contents of your submission will be emailed to our staff and not stored on our web server.

If you are accompanying a minor, please use this form.







    Consent

    I understand, acknowledge and agree that I have hired Laughing Buddha and/or their employee’s to stretch and or Insert jewelry into my piercing. These services may use tools which include but are not limited to; Insertion tapers and/or any ring expanding pliers, benders, closers, or addition tools needed to complete the procedure.

    Insertions and/or Stretches can cause the piercing to become sore, irritated, tender, inflamed and can at times cause a fully healed piercing to become irritated.

    Complications with such procedures could include symptoms such as but not limited to: swelling, bleeding, bruising, tenderness, irritability etc.

    I have been informed of the inherent risks associated with the procedure that I am requesting to have performed, and have been given the chance to ask any questions regarding said procedure.

    The Undersigned hereby voluntarily assumes any and all risk of injury, harm and/or damage resulting from or in connection with the above services.

    The Undersigned further agrees to indemnify and does indemnify the Releasees from any and all claims, demands, actions, liability and/or damages whatsoever whether arising from negligence or in any other manner made by any individual or entity against Laughing Buddha. related to my acts and/or omissions. The indemnification shall include, but shall not be limited all attorney’s fees and costs incurred.

    Medical Questionnaire

    The following medical questions are confidential, and solely used by the staff at Laughing Buddha Body Piercing to ensure the procedure is being performed safely.

    YESNO
    YESNO
    YESNO
    YESNO
    YESNO
    YESNO
    YESNO
    YESNO
    YESNO
    YESNO
    YESNO
    YESNO

    COVID-19 RELEASE

    The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact.

    The Empire Inc./ Laughing Buddha Body Piercing (“the Facility”) has put in place preventative measures to reduce the spread of COVID-19; however, infection from COVID-19 can happen anywhere and no business can guarantee or completely prevent someone from becoming infected. Further, being in any business could increase your risk of contracting COVID-19.

    We require a photocopy of your ID. You can take a picture with your phone and attach the image here.

    The undersigned for himself or herself, the heirs, successors, representatives as assigns hereby forever waives releases and discharges Laughing Buddha Body Piercing, their agents, employees, representatives, and other organizations affiliated with this studio and any and all of their heirs, successors or assigns (hereinafter referred to as Releasees.)

    The undersigned further agrees to indemnify and do indemnify the Releasees from any and all claims demands, actions, liability and/or damages whatsoever performed under this agreement. The indemnification shall include, but shall not be limited to any and all attorney fees and costs incurred.

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