New Statement. Msg-ID:#72391

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Name* This field is required.
First Name
Last Name
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Phone Number* This field is required.
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Date of Birth* This field is required.
Please notify if under 18.
Month
Day
Year
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Email Address* This field is required.
You will receive a copy of this form to your email address provided. This email will not be used for promotional or marketing emails.
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Medical Disclosure

Please discuss any medications, allergies, or medical history with your tattoo professional prior to your procedure. If you have or have been around anyone exhibiting symptoms of Covid-19, please make your artist aware of this. If you have a fever, or symptoms during your visit, you will be asked to reschedule.

Common allergens we use in our process:

1. Tea Tree

2. Coconut Oil

3. Mango

4. Latex

5. Medical Adhesive
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Please select any health conditions that apply, then discuss with your artist.
Fever
Cold/flu symptoms
Exposure to those with illness
Diabetes
Epilepsy
Bleeding disorder
Communicable Disease
Skin Condition
Pregnant/Nursing
Latex or Pigment Allergy
Low/High Blood Sugar
Heart Condition
Other
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Are you on any medications that may thin your blood or inhibit your ability to receive or heal your tattoo?* This field is required.
No
Yes
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Have you eaten within the last two hours?* This field is required.
No
Yes
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Are you under the influence of drugs or alcohol (more than 2 drinks)?* This field is required.
No
Yes
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Please read and agree to each of the following before moving forward. If you have trouble understanding, or questions about anything please let your artist/piercer know so that they can assist you.* This field is required.
I certify that I am 18 years of age, or a minor with proper parental consent and documentation.
I understand that minors cannot receive tattoo services or piercings in private areas (breasts, genital, or areolas) and that Studio 85 Tattoo will not tattoo on any area not covered by a t-shirt and jeans (no hands, neck, feet, face, or below elbows). I also understand that there are size and design restrictions for tattoos, and age restrictions on piercings.
I agree that the tattoo design is drawn to my specifications.
I understand that a tattoo is permanent.
I understand that there is a possibility of allergic reaction, infection, or health complications.
I agree to allow artistic interpretation and guidance from the tattoo or piercing professional who will be performing the procedure.
I agree to follow all instructions regarding the aftercare process of my tattoo or piercing.
I understand there is a chance I might feel lightheaded, dizzy and/or faint due to my decision to receive a tattoo or piercing and will notify my artist if this happens. Failure to do so releases Studio 85 Tattoo and all artists of any and all responsibility.
I understand it is my responsibility to check placement (piercing or tattoo) and approve all aspects to ensure the design meets my specifications, including but not limited to: spelling, accurate dates, translations, Roman numerals, and artistic elements.
I understand there are no refunds once work has been completed.
I understand that the cost of the tattoo is partially calculated due to time. Inability to sit still, excessive breaks, and extreme vocalization can increase the price of the session.
I understand that the artist has the right to discontinue service if I become disrespectful, rude, or too difficult to tattoo or pierce at my own expense.
I understand that my information may be used for effective contact tracing to ensure the safety of clients and staff.
I will, to the best of my knowledge, notify Studio 85 if I become aware that I may have been infected with Covid-19 at the time of my appointment.
I hereby release Studio 85 Tattoo and service providers of all responsibility for services I receive within.
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Please select your tattoo artist* This field is required.
James
Amanda
Dale
Jessie
Erik
Audrey
Paige (apprentice)
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Description and location of Tattoo* This field is required.
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Please take a photo of your I.D. (Driver’s license, State I.D., Temporary Permit, Passport, or Military I.D. ONLY). IF A MINOR: Please take both your photo ID and the ID of your legal guardian. If neither last name or address match, please notify your artist..
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Signature
Clear
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Date Signed* This field is required.
Month
Day
Year
Should be Empty: