healthy kids care

request that Healthy Kids Care (HKC) perform ear piercing for the patient listed below. I understand that ear piercing is a minor cosmetic procedure and involves certain risks.

By signing this form, I acknowledge and agree to the following:

1. Age Requirement
   I confirm that I am 18 years of age or older. If the patient receiving the ear piercing is a minor, a parent or legal guardian must sign this consent form.
2. Health Status
   I confirm that the patient does not have any known medical condition or is taking any medication that would make ear piercing unsafe, including conditions that may affect healing or increase the risk of infection.
3. Possible Risks
   I understand that although proper sterile techniques are used, possible risks may include infection, irritation, allergic reaction to metal, or scarring.
4. Procedure Information
   I understand that the ears will be pierced using sterile, medical-grade stainless steel piercing studs and equipment.
5. Aftercare Responsibility
   I agree to follow the aftercare instructions provided by Healthy Kids Care for the recommended period to help reduce the risk of infection or complications.
6. Release of Liability
   By signing below, I release and hold harmless Healthy Kids Care (HKC), its providers, employees, and affiliated staff from any claims, damages, or liabilities that may arise from the ear piercing procedure performed at my request, except in cases of gross negligence.