Paradise Tattoo Studio
Traditional Tattoo Consent Form
Client Information
Full Name
*
First Name
Last Name
Pronouns (optional)
Age
*
Date of Birth
*
-
Day
-
Month
Year
Date Picker Icon
Phone Number
*
Format: +44 000 0000 000.
Email
*
example@example.com
Appointment Date
*
-
Day
-
Month
Year
Date
Address
*
Street Address
Street Address Line 2
City
County
Postal / Zip Code
Your Artist today is:
*
Ceara
Fiona
Jen
Molly
Tanya
Guest Artist
CONTRAINDICATIONS:
It is important we have detailed information of any medical conditions; some conditions may affect you during your tattoo treatment and the tattoo healing process.
Please tick if any of the following conditions apply to you:
Cancer
Radiotherapy / Chemotherapy
Diabetes
Immunosuppressive Diseases
HIV, AIDS, Hepatitis
Asthma
High / Low Blood Pressure
Iron Deficient
Epilepsy
Infectious Diseases or Viruses
Haemophillia
Lymphoma
Heart Conditions or disease
Recent Surgery
Skin conditions, such as eczema, psoriasis or dermatitis
Blood Clotting Disorders
Blood Thinning Medication
Please specify details:
Please tick if you any of the following skin conditions apply to you:
Eczema (on or near the area to be treated)
Psoriasis (on or near the area to be tattooed)
Dermatitis (on or near the area to be tattooed)
Keloid Scarring
Impetigo
Active Acne (on or near the area to be tattooed)
Hyper / Hypo Pigmentation
Do you have any known allergies? Please Specify:
Disclaimer
Please tick to confirm and agree to the following terms and conditions.
I am over 18 years of age
*
Yes, I am
I am not under the influence of alcohol or drugs
*
No, I am not
I feel fit and well to have my treatment done today, and am showing no signs of illness or fever.
*
Yes, I am feeling in good health
I have carefully read, followed and understood any pre-appointment advice given to me in my confirmation emails.
*
Yes, I have
I am not pregnant or breast feeding.
*
No, I am not
I understand that traditional tattooing is an art and not an exact science. I understand that results may vary depending on skin types, age, lifestyle etc.
*
Yes, I understand
I understand that I must inform my medical specialist of my traditional tattoos if I require an MRI at anytime after my treatment.
*
Yes, I understand
I allow for photographs to be taken of my tattoo and give permission for them to be kept on file and used for the educational and promotional purposes by my artist and Paradise Tattoo Studio Ltd. (The use of my name and/or full face will be kept confidential upon request.)
*
Yes, I allow
I understand that once I leave the sterile environment of the studio, it is my responsibility to care for my tattoo and, if in the rare case, complications incur during healing, I will seek medical advice immediately. I also accept that my tattoo is an open wound, and is not possible to be kept in completely sterile conditions once leaving Paradise Tattoo Studio, so a risk of infection is always possible.
*
Yes, I understand
I confirm that all details of my tattoo will be discussed and agreed upon verbally before the tattoo is carried out, and that my artist will be responsible for keeping a detailed recorded in my personal file.
*
Yes, I confirm
Declaration
I confirm that all details I have given are correct and to the best of my knowledge.
*
Yes, I confirm
By submitting this form I agree and consent to my procedure and give permission to my artist to keep my details, protected under the Data Protection Act (2018).
*
Yes, I agree and consent
Signed Date
*
-
Day
-
Month
Year
Date
Client Signature
*
Please keep me updated on news and offers at Paradise?
*
Yes
No
Submit
Should be Empty: