Tattoo Consent Form
Client Information
Name
First Name
Last Name
Legal name (If different)
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Date
Phone Number
Format: (000) 000-0000.
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
Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
Yes
No
Do you have any skin conditions?
Yes
No
Do you have an allergy to medical grade adhesives such as saniderm/tegaderm or medical tape?
Yes
No
Do you understand that the use of lidocaine or any other numbing or pain relief products is done at your own discretion, and that the use of these products can potentially hinder the process of the tattoo or result in potentially serious allergic reaction.
Yes, I understand
If yes to previous questions, please list any skin or medical conditions which may effect the tattoo process.
If yes, please identify the condition.
Please tell about your personal medical history that your tattoo artist should be informed of for the tattooing process (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease, allergies 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 and it is my responsibility to inform the artist before leaving the studio if there is anything unsatisfactory about my tattoo or experience.
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 artist.
I understand that Infection is a risk and will follow my artist’s instructions on proper care.
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
Take Photo
Submit
Should be Empty: