Snowbird Studio - Tattoo Consent Form
Client Information
Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Date
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
FEMALE ONLY: Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
Yes
No
Do you have any skin conditions?
Yes
No
Please elaborate on any pertinent diseases or skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo.
I allow my tattoo to be photographed and used on the artist's portfolio.
Other
I acknowledge it is not reasonably possible for the artist to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.
I understand that it is my responsibility to take care of the tattoo by following the aftercare instructions given to me.
I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing.
I realize that variations in color and design may exist between any tattoo as selected by me and as applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.
I confirm that the information I provided in this document is accurate and true.
Please upload a photo of your drivers license:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signed Date
-
Month
-
Day
Year
Date
Client Signature
Submit
Should be Empty: