Exotic Impressions Body Piercing
8780 Rivers Avenue 10150 Dorchester Road
North Charleston, SC 29406 Summerville, SC 29485
(843) 797-2280 (843)419-6527
In South Carolina, anyone under the age of sixteen is required to have proof that they have no medical complications that may affect their piercing. If you have any medical issues such as hemophilia, diabetes, allergies, recent surgeries, skin conditions, or any other conditions that may affect your piercing, your doctor may advise against the procedure.
I have read all aftercare instructions associated with this procedure and have had the opportunity to ask questions. I understand that bruising, scarring, and infections may occur and are possible risks associated with piercings. Certain health conditions may further increase the chance of infection or complications during the healing process. As such, I will consult my physician if any problems should occur.
Client’s Name ______DOB ______
Client’s Signature ______Date ______
As the physician of the patient above, I understand that the patient intends to have a piercing performed at Exotic Impressions. I am willing to treat the patient should any complications arise.
My willingness to treat the patient is in no way an endorsement of the practice of piercing.
Physician’s Signature ______Date ______
Exotic Impressions Body Piercing
8780 Rivers Avenue 10150 Dorchester Road
North Charleston, SC 29406 Summerville, SC 29485
(843) 797-2280 (843)419-6527
In South Carolina, anyone under the age of sixteen is required to have proof that they have no medical complications that may affect their piercing. If you have any medical issues such as hemophilia, diabetes, allergies, recent surgeries, skin conditions, or any other conditions that may affect your piercing, your doctor may advise against the procedure.
I have read all aftercare instructions associated with this procedure and have had the opportunity to ask questions. I understand that bruising, scarring, and infections may occur and are possible risks associated with piercings. Certain health conditions may further increase the chance of infection or complications during the healing process. As such, I will consult my physician if any problems should occur.
Client’s Name ______DOB ______
Client’s Signature ______Date ______
As the physician of the patient above, I understand that the patient intends to have a piercing performed at Exotic Impressions. I am willing to treat the patient should any complications arise.
My willingness to treat the patient is in no way an endorsement of the practice of piercing.
Physician’s Signature ______Date ______