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In consideration of receiving a piercing from Thirdeye Beauty and Wellness LLC including its artists, associates, apprentices, agents, or any employees (hereinafter referred to as the “Tattoo Studio” I agree to the following:


**If you are under the age of 18 you will need a signed and notarized form provided by Thirdeye Studio. We donot provide notarizing service. Parent or guardian must be present during piercing for anyone under 16.** 

Doctor or Physician Office
I will provide my own below
Jupiter Medical Center , 1210 Old Dixie Hwy, Jupiter FL 33458, (561)-263-2234

I understand there is a possibility of an allergic reaction to the jewelry inserted into the fresh body piercing. I understand there is a possibility of getting an infection, and I have been advised of the signs and symptoms of infection that indicate a need to seek medical attention. agree to follow all instructions concerning the care of my body piercing.

Piercing Artist
Nikki Arensman
Date and time

--------------ARTIST USE BELOW THIS ------------------

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