• Tattoo Consent Form

    Maggie Stockman Green @ lilpeggyhill
  • Date*
     - -
  • Your Date of Birth*
     - -
  •  -
  • I acknowledge that I am receiving my tattoo in the following location:*

  • Acknowledgment

    I acknowledge by signing this consent form that I have been given the full opportunity to ask any questions which I might have about obtaining a tattoo and that all of my questions have been answered to my full satisfaction. The tattoo artist will use new needles for the tattoo and provide care instructions once the tattoo is complete. I hereby release my tattoo artist and this studio from all liability, claims, actions, and demands in law, or in equity, which I may have by obtaining this tattoo. I also acknowledge I have truthfully and accurately answered the questions listed below

  • Are you over 18 years old?*
  • Have you been jaundice (yellowing of skin or eyes) in the past 10 days?*
  • Are you prone to fainting?*
  • Do you have diabetes?*
  • Do you have difficulty stopping bleeding?*
  • Do you take any blood thinners?*
  • Do you have any heart related problems?*
  • Do you have epilepsy?*
  • Do you have high blood pressure?*
  • Do you have any known allergies?*
  • Have you consumed any anticoagulants (aspirin, ibuprofen, etc) in the past 8 hours?*
  • Have you consumed any food in the last 3 hours?*
  • Do you have any conditions that may affect the healing of this tattoo?*
  • Are you pregnant or nursing?*
  • Are you under the influence of alcohol or drugs?*
  • Do you have any medical or skin conditions, like acne, scarring, psoriasis, or sunburn that may interfere with your tattoo?*
  • Do you acknowledge that it's reasonably not possible for your tattooer to determine wether you might have an allergic reaction to tattoo ink, and accept that risk of an allergic reaction is possible?*
  • Do you acknowledge that infections are always possible as a result of being tattooed, during the tattoo or if you don't take proper care of it during the healing stages?*
  • Do you acknowledge that any touch up, if needed, will be done at your own expense?*
  • Do you acknowledge that variations in color and design between the tattoo as selected and as ultimately applied to your body may occur?*
  • Do you acknowledge that your tattoo artist is not responsible for the meaning or spelling of the symbol or text you provided to them*
  • Do you acknowledge that any skin treatments, laser hair removal, plastic surgery or other skin altering procedures may adversely affect your tattoo?*
  • Do you acknowledge that a tattoo is a permanent change to your appearance, and that no promises have been made to you about the ability to later change or remove the tattoo?*
  • Do you agree to pay your artist's quoted amount upon completion of the tattoo by credit, debit or cash (plus taxes when applicable)?*
  • Do you release all rights to any photographs taken of you by your tattoo artist and give consent in advance to their reproduction in print or electronic form?*

  • If no, please remind your tattoo artist not to take pictures of you and your completed tattoo. 

  • I understand that I am opting for a service that is not urgent and not medically necessary.*
  • I understand all the risks including those noted herein and I would like to proceed with this service.*
  • I understand the explanation and consent to the procedure.*

  • By signing this form, I reaffirm the answers provided above. 

  • Date*
     - -

  • STOP!

    Bring your ID and this form to your artist for their signature.

    Please do not submit before the artist has signed!

     

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