Tattoo Consent Form
Client Information
Full Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Pre-Procedure Questionnaire
Are you pregnant or Nursing?
*
Yes
No
Do you have any condition that requires you to take medications such as anticoagulants that thin the blood or interfere with blood clotting?
*
Yes
No
Do you have a communicable (transferrable) disease?
*
Yes
No
Location of the body getting tattooed? (upper arm, lower arm, thigh, hamstring ribs etc.)
If yes, please identify the condition.
Skin conditions (Rashes, eczema, infection, psoriasis, freckles, Skin lesions, sensitivity to soap or disinfectant etc.)
If yes, please identify the condition.
Medical History (Diabetes, Hemophilia, Seizures, Fainting, Narcolepsy, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
*
I understand that I cannot be under the influence of drugs or alcohol prior to or during my appointment. I am voluntarily submitting myself to receive body art without duress or coercion.
*
I understand that this procedure is a permanent change to my skin and body, and may only be removed with a surgical procedure.
*
I understand that any effective removal of a tattoo may leave scarring.
*
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 good care of my tattoo.
*
I indemnify and hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities.
*
I understand technician will not perform the body art procedure if I fail to complete or sign this form. further, the technician may decline to perform the tattoo if the I identify any health conditions.
*
I confirm the following: the information I provided in this document is accurate and true, I am the person on the legal ID presented, I am at least 18 years of age, and I willfully consent to getting a tattoo.
Take Photo of ID (DRIVERS LICENSE, PASSPORT, TRIBAL ID CARD, MILITARY ID, PERMANENT RESIDENT CARD (GREEN CARD)
*
Signed by both parties on date:
*
-
Month
-
Day
Year
Date
CLIENT SIGNATURE
*
TATTOO ARTIST SIGNATURE
*
Submit
Should be Empty: