• Client Information

    Tattoo Consent Form
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  •  -

  • Pre-Procedure Questionnaire

  • Have you ever been tattooed before?*
  • Are you under the influence of drugs or alcohol?*
  • Are you pregnant or breast feeding?*
  • Do you have a heart condition?*
  • Do you have a skin condition?*
  • Do you have a communicable disease?*
  • Are you a hemophiliac?*
  • Do you get keloids?*
  • Are you epileptic?*
  • Do you have diabetes?*
  • Do you have a tendency to faint?*

  • Health Risk Awareness

    It is important to be aware of the potential health risks associated with tattooing such as allergic reactions (including but not limited to allergic reactions to tattoo pigment, latex gloves and/or soap), skin infections, hepatitis, prolonged bleeding, swelling, scarring, difficulties in detecting melanoma and general discomfort. Existing medical conditions such as allergies, heart disease, diabetes, skin disorders or conditions that affect the immune system may increase the risk of complications from tattooing.

    I also state that I have not excluded any important health conditions that I have had or may have. I have been informed of the potential risks associated with getting a tattoo, yet I wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks that may arise from tattooing. I will follow the aftercare instructions provided by Ransom Tattoo Gallery.

    Therefore, I hereby release any and all persons representing Ransom Tattoo Gallery from all responsibility. I accept any and all responsibility myself for the consequences that might stem from my decision to have any tattoo done by a Ransom Tattoo Gallery artist. I agree to not sue Ransom Tattoo Gallery for damages from my decision to have any tattoo work. I agree for myself, heirs and legal representatives to hold Ransomt Tattoo Gallery harmless of all damages, actions, causes of action, claim judgements, costs of litigation, attorney's fees and all other expenses which might arise from my decision to have any tattoo related work done by Ransom Tattoo Gallery. I hereby acknowledge that by signing this agreement, I certify that all information provided is true.

    It is a violation of Section Article 4-A, Section 260.21 to tattoo minors under the age of 18, regardless of parental consent.

  • Please indicate your artist

  • Photo of your ID*
  • Date of Appointment
     - -
    2 digit month, 2 digit day, 4 digit year

  • Did you park in front of the shop? If the answer is yes, you gotta move your car! The meter maid tickets if you're there longer than 15 minutes!

  • Should be Empty: