Tattoo Consent Form
Client Information
Full Name
First (Legal)
First (Preferred)
Last Name
Pronouns
She/Her/Hers
He/Him/His
They/Them/Theirs
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
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
Yes
No
Are you Pregnant or Nursing?
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Medical History (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Tattoo Information
Description of Tattoo
Name of Tattoo Artist
Aaron
Alina
Paige
Lexi
Syd
Soodie
Amir
Guest
Acknowledgment and Waiver
*
I understand that this procedure is a permanent change to my skin and body.
I allow my tattoo to be photographed and be used for portfolio purposes.
*
I acknowledge that NEXT does not offer refunds.
*
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 NEXT.
*
I understand that I might get an infection if I don't follow the instructions given to me in regards to taking good care of my tattoo.
*
I indemnify and hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities.
*
I confirm that the information I provided in this document is accurate and true.
Signed Date
-
Month
-
Day
Year
Date
Client Signature
Back
Next
COVID-19 Information and Screening
I understand the following:
*
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by theWorld Health Organization. COVID-19 is extremely contagious and is believed to spreadmainly from person-to-person contact.I understand that COVID-19.
NEXT BODY ARTS 2019 INC (“the Facility”) has put in place preventative measuresto reduce the spread of COVID-19; however, infection from COVID-19 can happen anywhereand no business can guarantee or completely prevent someone from becoming infected.Further, being in any business could increase your risk of contracting COVID-19.
To prevent the spread of contagious viruses and to help protect others, I understandthat I will have to follow the facility’s guidelines. The facility’s guidelines can be changed atanytime as new information and technology become available
I confirm that I am not presenting any of the symptoms of COVID-19 including: dry cough, runny nose, sore throat, shortness of breath, loss of sense of taste or smell, fever.
I confirm that I have not been in close contact with anyone with these symptoms oranyone who has been diagnosed with COVID-19 in the past 14 days
I understand that air travel significantly increases my risk of contracting and transmittingthe COVID-19 virus. I verify that I have not traveled outside of British Columbia in the past 14 days.
Submit
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