Tattoo Consent Form

Tattoo Consent Form
Client Information
Full Name

First Name Last Name
Age *
Date of Birth *

Month Day Year
Date
Phone Number

Area code (if applicable) Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?

Yes No
FEMALE ONLY: Pregnancy or Nursing?

Yes No
Do you have a communicable disease?

Yes No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Medical History (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
I understand that this procedure is a permanent change to my skin and body.
I allow my tattoo to be photographed and be used for Tattoo Shop portfolio showcased.
I acknowledge that the Tattoo Shop does not offer refund.
I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.
I understand that I need to take care of the tattoo by following the instructions given to me by the Tattoo Shop.
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking food care of my tattoo.
I indemnify and hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities.
I confirm that the information I provided in this document is accurate and true.
Signed Date

Month Day Year
Date
Client Signature *

Clear
Photo ID; *

Browse Files
Over 18s Only. Photo ID only, drivers license or passport. No ID, No Tattoo. Cancel of
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Tattoo Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver