Tattoo Consent Form
Sim1nk Tattoo & Beauty Studio
29 High Sreet North, Ruskington, Sleaford, Lincolnshire, NG34 9DY
Client Information
Full Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
County
Post code
Pre-Procedure Questionnaire
Who is performing your Tattoo today?
Sim
Tym
Kirsty
Are you under the influence of drugs or alcohol?
Yes
No
Do you bleed or bruise easily?
Yes
No
Do you suffer from allergic responses to adhesive plasters/creams/Latex or metals (such as nickel)
Yes
No
If you answered 'Yes' What are you allergic too?
Are you prone to fainting or dizziness? Have you ever fainted whilst having a treatment or procedure?
Yes
No
Have you taken any medication, including aspirin or ibuprofen in the last 48 hrs?Medication name:
Yes
No
FEMALE ONLY: Are you pregnant or Breast feeding?
Yes
No
Do you suffer from high blood pressure or diabetes?
Yes
No
If you answered yes? What condition do you have? Are you taking any medications?
If yes, please identify the condition.
Do you have any skin conditions? (e.g. Rashes, eczema, infection, psoriasis, raised moles, etc.)
Yes
No
If you answered yes? please describe your skin condition
If yes, please identify the condition.
Medical History (e.g. Cardiovascular Disease, Epilepsy, Blood-related disease 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 have requested this tattoo of my own free will and this is undertaken at my own risk.
Everyone’s body is different and can lead to different reactions to a tattoo. I understand that not all people can be tattooed. Once I have left the studio I agree my Tattoo is my sole responsibility, I agree to follow the advice given on the aftercare leaflet and I understand that a new tattoo is susceptible to infection until healed.
I understand that every care has been taken to ensure that my tattoo is carried out in a hygienic way using sterile instruments and Ink, including pre sterilised single use needles.
I hereby confirm that I understand the above information and that the information given to be is true to the best of my knowledge.
I allow my tattoo to be photographed and images shared on social media and on the studio's website.
I do not want my Tattoo to be photographed and shared online.
I have applied numbing cream? I understand that I am fully responsible for any adverse reactions that may occur from using anesthetic numbing products and that numbing cream can effect the healing of a new tattoo.
I agree that Sim1nk Tattoo 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 aftercare advise given to me by Sim1nk Tattoo studio.
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 new tattoo.
I am being 18 years of age or over and fully aware of the irreversible nature of the service to be provided, hereby certify that I do not suffer from any blood or skin disease or allergy or nervous complaint, I will follow the after-care recommendations provided and agree to indemnify and keep indemnified the tattooist completing my procedure and the Tattoo studio business owner against all claims or proceedings in respect of any personal injury or damage a rising out of, or as a result of being Tattooed.
I confirm that the information I provided in this document is accurate and true.
Signed Date
-
Month
-
Day
Year
Date
Client Signature
If you are under the age of 25 you must provide photo I.D Please tick which form of I.D you will be presenting
Driving License
Provisional Driving License
Student Card
Passport
Other
Submit
Should be Empty: