I was offered and have used hand sanitizer. I don't have COVID symptoms and I haven't been diagnosed with COVID in the last 14 days. I was given the option of having my temperature taken. Evolved has offered to sanitize my phone with their UV apparatus. I am wearing a face mask or face covering unless I fall into one of the categories that grants exemptions.
*
I feel great!
What brings you in today?
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Tattoo
Piercing
Both!
Jewelry Change
FOR TATTOOS: I have spoken with or will speak to my artist about the details of my tattoo design. I have checked, double-checked, and even triple-checked(!) spelling, grammar, punctuation, size, placement, color, and everything else related to my tattoo. I understand that it is MY sole responsibility to ensure that my tattoo is accurate and exactly how I want it. If I am getting a tattoo in a compromised area (feet, hands, neck, face, etc.), I have spoken with my artist and am aware that the work is not guaranteed because of the location of its placement.
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I agree
FOR PIERCINGS/JEWELRY CHANGES: I understand that Evolved is not responsible for the loss or damage of any jewelry and agree to release them from any claim related thereto.
*
I agree
Which location are you at?
2520 Summit St.
1980 N. High St.
2413 N. High St.
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CLIENT INFORMATION:
Parents and legal guardians of minors receiving a tattoo or piercing, please fill out your information at the end of the form.
Your Chosen Name
Government Name
*
First Name
Last Name
Your Pronouns
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
January
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1
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Year
Date
-
Month
-
Day
Year
Date
Age
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FOR MINORS
Please read through the following
Being of sound mind and body and of the age of majority (at least eighteen (18) years old), I hereby voluntarily release and forever hold harmless Evolved, Inc./Skin FX, Inc. and any and all of its representatives, including, but not limited to employees, contractors, interns, apprentices, volunteers, or assigns (hereinafter referred to collectively as “Evolved”) from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo/piercing, from myself, my heirs, assigns, or legal representatives.
*
I agree
I voluntarily release and forever hold harmless Evolved from any and all consequences that stem from my tattoo/piercing, whether or not Evolved is negligent.
*
I agree
I agree for myself, my heirs, assigns, and legal representatives to hold Evolved harmless and not responsible for any damages, actions, causes of action, loss of jewelry, claim judgments, cost of litigation/attorney fees, and all other costs and expenses which may arise from my decision to have any tattoo, piercing, or any other work done by Evolved.
*
I agree
I understand that Evolved is not a medical provider and any and all advice offered is NOT medical advice.
*
I agree
I hereby give Evolved permission to use any image of my piercing/tattoo/person.
*
I agree
I agree I will verbally remind my artist to not take/use my picture
I have not consumed or been under the influence of any drug and/or alcohol for the past 24 hours.
*
I agree
I do not have any conditions or communicable diseases (i.e. diabetes, hepatitis, HIV, heart conditions, epilepsy, hemophilia, etc.), other than those that I have directly communicated to Evolved, that could inhibit the healing of my tattoo or piercing. I understand that I should discuss any concerns with my artist.
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I agree
I do not have any skin conditions (i.e. keloidal scarring, eczema, severe acne, etc.), other than those that I have directly communicated to Evolved, that could inhibit the healing of my tattoo or piercing. If I do, I am aware of the potential risks and understand that I should discuss any concerns with my artist.
*
I agree
I have no physical, mental, or medical condition that will be adversely affected by receiving a tattoo or piercing.
*
I agree
I acknowledge that it is not possible for Evolved to determine whether I will have an adverse reaction to materials used during my piercing and/or tattoo and/or the duration of the healing.
*
I agree
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I have advised Evolved and verbally informed my artist of all allergies including, but not limited to: Jewelry Materials - ASTM F136 Implant Grade Titanium, ASTM F138 Surgical Stainless Steel, Gold, Pyrex, etc.
*
None
I have advised Evolved and verbally informed my artist of all allergies including, but not limited to: Tattoo Inks - Starbrite, Intenze, Dynamic, Eternal, Waverly, Fusion, One, Victory, Silverback, KuroSumi, etc.
*
None
I have advised Evolved and verbally informed my artist of all allergies including, but not limited to: Latex, Nitrile, Gentian Violet, Lidocaine, NeilMed Saline Spray, Listerine, PureKlenz, Technicare, Green Soap, Dr. Bronner’s, Vitamin E oil, Vitalitree, Jojoba Oil, Emu Oil, A&D Ointment, Aquaphor, H2Ocean Cream, Aquatat, Isopropyl Alcohol, Recovery Brand Occlusive Bandage, Medical Tape, etc.
*
None
I have received - or will receive - an Aftercare Sheet and agree to follow all instructions regarding my tattoo or piercing. I will read the Aftercare Sheet and ask any questions I have prior to leaving the studio. I have been given contact information for the studio and understand that I can call during business hours.
*
I agree
I understand that there is a risk of infection with any tattoo or piercing. I also understand that following the aftercare instructions will minimize that risk.
*
I agree
I am not prone to fainting or losing consciousness. If I am, I have verbally informed my artist.
*
I agree
I am not pregnant.
*
I agree
I have eaten in the past 4 hours.
*
I agree
I certify under penalty of perjury that the above information is true and correct.
*
I agree
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FOR PARENT/LEGAL GUARDIAN OF MINOR
Please read through the following
Parent's Name
*
First Name
Last Name
Preferred Name
Your Pronouns
I hereby release any and all persons representing Evolved from any responsibility. I accept any and all responsibility myself for any consequences that might stem from my request to have any work done by Evolved on my child.
*
I agree
I agree not to seek reparations from Evolved in connection with any and all damages, claims, demands, rights, and causes of action of whatever kind or nature, based upon injuries or property damage to myself or any other persons arising from our decision to have work done at this time, whether or not caused by any negligence of Evolved.
*
I agree
I agree for myself, my heirs, assigns, and legal representatives to hold Evolved harmless and not responsible for any damages, actions, cases of action, claim judgments, cost of litigation/attorney's fees, and all other costs and expenses which may arise from my decision to have any tattoo, piercing, or any other work done by Evolved on my child.
*
I agree
I certify under Penalty of Perjury that the above information is true and correct.
*
I agree
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Please attach a copy of your valid, legal ID:
*
Click here to take/upload photo of your ID
Identification that we accept: Driver's license (that's not expired, temporary papers from the BMV are fine), State IDs, and Passports.
Cancel
of
For Minors - Please attach a copy of your birth certificate and your ID:
Click here to take/upload photo of your ID and birth certificate
Identification that we accept: Driver's license (that's not expired, temporary papers from the BMV are fine), State IDs, Passports, School ID (with photo), Recreational pass (with photo), etc. If you have any questions about an ID for your child, please let us know. We'd be happy to help!
Cancel
of
For Parents/Guardians of Minors - Please attach a copy of your valid, legal ID and any other needed documentation:
*
Click here to take/upload photo of your ID
Identification that we accept: Driver's license (that's not expired, temporary papers from the BMV are fine), State IDs, and Passports.
Cancel
of
Date
*
-
-
Signature
*
Clear
Minor's Signature
*
Clear
Parent or Legal Guardian's Signature
*
Clear
Submit
Should be Empty: