Tiny Tattoo Consent Form
Client Information
Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Date
Phone Number
Email
example@example.com
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
Yes
No
Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
Yes
No
Do you have any skin conditions?
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, keloids, 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.
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 used for the good brow’s portfolio/instagram/facebook advertising.
*
I acknowledge that the good brow does not offer any refunds.
*
I agree that the good brow 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 the good brow.
*
I understand that I could get an infection if I don't follow the instructions given to me in regards of taking care of my tattoo.
*
I hold harmless the good brow 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
Submit
Should be Empty: