Tattoo Consent Form

Tattoo Consent Form

All-Star Tattoo Co. LLC
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 State / Province

Postal / Zip Code
Instagram @
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol? *

Yes No
Pregnant or Nursing? *

Yes No
Do you have a communicable disease? *

Yes No
List any Skin conditions (e.g. Rashes, eczema, infection, psoriasis, etc.)
If yes, please identify the condition.
List any Medical Conditions that may affect the tattoo/piercing process (e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
*

I have been fully informed of the inherent risks associated with getting a Tattoo/Piercing. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to: infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex, or soap. Having been informed of the potential risks, I still wish to proceed with the Tattoo and I freely accept and expressly assume any and all risks that may arise from the Body Art procedure.
*

I waive and release to the fullest extent of the law all of the Artists/Technicians and All-Star Tattoo Co. LLC. from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors, or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the application of my Tattoo/Piercing, whether caused by the negligence or fault of either the Artist/Technician or All-Star Tattoo Co. LLC.
*

I agree that the Artist/Technician and All-Star Tattoo Co. LLC have given me full opportunity to ask any and all questions regarding my Tattoo/Piercing, and all of my questions have been answered to my satisfaction.
*

I understand that I need to take care of the tattoo/piercing by following the instructions given to me by the Artist/Technician. I acknowledge that it is possible the tattoo/piercing can get infected, particularly if I do not follow the aftercare instructions given. If any "Touch-up" work to the tattoo is needed, I agree that the work will be done at my own expense.
*

I release all rights to any photographs taken of me and the tattoo and give full consent in advance to their use in print or electronic form.
*

I acknowledge that neither the Artist/Technician or All-Star Tattoo Co. LLC is responsible for the meaning or spelling of the symbol or text I have chosen. Variations in color and design may exist between the art I have selected and the actual tattoo. I also understand that over time, the colors and clarity of my tattoo will fade over time.
*

I confirm that the information I provided in this document is accurate and true.
Artist *
Tattoo Design *
Description of WHAT you're getting
Body Location of Tattoo *
WHERE ie: Left upper arm, Right ankle, etc...
Signed Date

Month Day Year
Date
Take a Pic of and upload a photo of YOUR DRIVERS LICENCE *

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Client Signature *

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Tattoo Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver