Froglounge Consent Form
Please fill out this form either the day of, or day before your tattoo :)
Your Information
Your name
First Name
Last Name
Pronouns
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Your Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Who is your artist today?
Description of tattoo
Pre- Tattoo Questionairre
Are you under the influence of drugs/ alcohol?
Yes
No
Are you going on holiday somewhere sunny within the next 3 weeks?
Yes
No
Are you pregnant or breastfeeding?
Yes
No
Do you suffer from any of the following?
*
Rows
Yes
No
Heart condition
Epilepsy
Haemophilia/ other blood clotting disorders
Diabetes
Any past issues with skin healing (eg. Psoriasis/ eczema) ?
Keloid scarring of previous tattoos
Fainting
Are you allergic to anything? (eg: latex, medical adhesive, creams, metals, food)
Yes
No
If “yes” please specify allergies
Please specify if you are on any medications
Any other information you think we need to be aware of. Let us know if there is anything we can do to make you more comfortable during your appointment :)
Declaration
I declare that I give my full consent to tattooing being carried out by the aforementioned practitioner. I confirm that potential complications, (eg infection/ swelling) for the procedure undertaken and aftercare instructions have been explained to me. A written aftercare advice sheet containing more detailed information has been given to me and I agree that it is my responsibility to read this and follow the instructions on it, until the site has healed.I confirm that the above information provided by me for this consent form is correct to the best of my knowledge, that I am over the age of consent for this procedure (as explained to me by the practitioner) and that I am not currently under the influence of alcohol or drugs.
Signature
Do you provide consent for photos/ videos of your tattoo being taken for use on our business social media
Yes
No
Submit
Should be Empty: