Tattoo Consent Form

Tattoo Consent Form
Client Information
Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Type of ID used for proof of age:
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Pre-Procedure Questionnaire
Are you pregnant or Nursing?
Do you have any condition that requires you to take medications such as anticoagulants that thin the blood or interfere with blood clotting?
Do you have a communicable (transferrable) disease?
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
Signed by both parties on date:

MonthDayYear
Date
CLIENT SIGNATURE
TATTOO ARTIST SIGNATURE
Should be Empty:

Client Information