Client record · Draft for Health Authority approval
Piercing client evaluation & informed consent
This draft is designed around Georgia Department of Public Health Rule 511-3-8. It must be reviewed and approved by the applicable Health Authority before operational use.
1. Client information
2. Procedure information
3. Client health evaluation
Check yes or no and discuss any “yes” response with the body artist before the procedure.
Diabetes or a condition/medication affecting the immune or neurological system☐ Yes ☐ No
Hepatitis B, Hepatitis C, HIV, or another bloodborne condition☐ Yes ☐ No
Bleeding disorder or medication that affects clotting☐ Yes ☐ No
Allergy or sensitivity to metals, latex, adhesives, cleansers, or medications☐ Yes ☐ No
Skin disorder, rash, lesion, infection, or open wound near the procedure area☐ Yes ☐ No
History of fainting, seizures, or adverse reaction during a procedure☐ Yes ☐ No
Pregnancy, nursing, or another condition relevant to healing☐ Yes ☐ No
4. Informed consent
5. Minor client addendum — age 8 through 17
A parent or legal guardian must remain present. Nipple and genital piercings are prohibited for minors. Studio policy may restrict additional procedures by age or anatomy.