Tattoo Consent Form
Client Information
Name
*
First Name
Last Name
Prefered name
Prefered pronouns
Age
*
Birth Date
*
-
Day
-
Month
Year
Date
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Artist
Name of your tattoo artist
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
Communicable diseases (e.g. Tuberculosis, Coronavirus, Dengue, Hepatitis, Measles, HIV/AIDS. etc.)
If yes, please identify the condition.
Do you have any skin conditions?
*
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Please tell about your medical history (e.g. diabetes, cardiovascular disease, epilepsy, blood-related disease, blood thinning medication, hypermobility/EDS, chemo or radiotherapy 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 for those photos to be used on my artist and Blank Collective's websites and social media accounts.
*
I acknowledge that Blank Collective does not offer refunds.
*
I agree that the studio 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 my artist.
*
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo.
*
I indemnify and hold harmless both Blank Collective Ltd. and my artist against any claims, expenses, damages, and liabilities.
*
I confirm that the information I provided in this document is accurate and true.
Signed Date
-
Day
-
Month
Year
Date
Client Signature
*
Please upload a photo of a valid form of ID (passport or driving license).
*
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