Emytattoos consent form

Today's Date

Please read and initial each of the statements below

I certify I am over the age of 18.

I am the person on the legal ID presented as proof that I am at least 18 years of age.

I understand that a tattoo is considered permanent and may only be removed with a surgical/Laser procedure.

I understand that any effective removal of a tattoo may leave scarring.

I have been informed of the nature, risks, and possible complications, and consequences of a permanent tattoo. I understand the permanent procedure carries with it known and unknown complications and consequences associated with this type of procedure, including but not limited to temporary minor bleeding, bruising of skin surfaces, swelling, redness, temporary discoloration, infection, scarring, inconsistent color, and spreading, fanning or fading of pigments.

I request the permanent tattoo procedure/s and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure/s. I certify that I am not under the influence of drugs or alcohol, I am not pregnant or nursing, and I consent to have the tattoo procedure listed above performed today.

I understand that any skin treatments (Retin A, Renova, Alpha Hydroxy and Glycolic Acids, laser hair removal, plastic surgery, or other skin altering procedures) may result in adverse changes to my tattoo.

I understand that sun, tanning beds, pools, some skincare products, and medications can affect my tattoo.

I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue. I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and have possibilities ofcomplications during and/or following the procedures such as infection, poor color retention, and hyper-pigmentation.

I understand that my technician only utilizes sterilized, disposable equipment to minimize the risk of infection or contamination and that my technician has received training in appropriate sanitation and hygiene techniques prior to performing any procedures. While the risk of infection from our procedures is extremely small, the possibility of such an occurrence cannot be totally prevented. Accordingly, I understand and accept the risk and release my technician and the business from any and all liability related to the subject procedure, except instances involving gross negligence.

I understand that implanted pigment color can slightly change in color or in shape and fade over time dueto circumstances beyond my technician's control. I understand that I may need to maintain the color with future applications at my own expense.

I accept the responsibility of explaining to my technician my desire for specific colors, shapes, and positioning for any procedure done today. If applicable, I have also confirmed all spelling and grammar necessary in the procedure. I understand that after my service, there will be no refunds. No exceptions.

If I have any signs or symptoms of infections I will seek medical care. Signs of infection include but are not to redness, swelling, tenderness of the procedure site, a red streak going from the procedure site towards the heart, elevated temperature, or drainage from the procedure site.

I have received post care instructions and I agree to follow them to the best of my ability. I understand that to follow the pre and post care instructions may negatively affect my final result. I agree that any touch up needed due to my negligence will be done at my own expense.

I understand that there is a chance that I might feel lightheaded or dizzy during or after being tattooed. I agree to immediately notify the artist in the event I feel lightheaded, dizzy, and/or faint before, during or after the procedure.

By signing below:

I have read or have had read to me the contents of this whole form. I understand the risks and alternatives involved in this/these procedure(s), and I have had the opportunity to ask questions, and all of my questions have been answered. I accept full responsibility for having this tattoo procedure done and understand that there is a no refund policy. I acknowledge that I have reviewed and approved the material given to me.

Name Printed

Signature

Please add photo of ID

Date

Technician Name

Release Agreement

La Luna Studio Consent Form