Client consent form

Name
Date of Birth

MonthDayYear
Date
Pronouns
Mine are she/her
Address
Email
example@example.com
Would you like to join my priority club?
Get dibs on upcoming designs,rewards, discounts, cancellations and flash day events.
Description of design
Medical questions: (answering yes to any of the following questions does not automatically mean that you will not be able to be tattooed, but it may mean that your artist needs to adjust how they are working)

Do you have any history of epilepsy or seizures?

Do you have skin conditions? (e.g. eczema, dermatitis, psoriasis)

Do you have any blood-borne illnesses or viruses?

Do you take any prescription medication?
If you have answered yes to any of the above questions, please provide any clarification you can here
If you run out of room just let me know in person!
Proof of Age of Client and Type of ID used
What Type of ID do you have?
FOR CLIENT'S INFORMATION
Known (potential) risks associated with tattooing

Localised Swelling Around The Site

Known (potential) risks associated with tattooing

Scarring Blood Poisoning (Septicaemia)

Individual Consent I declare that I give my full consent to the tattooing being carried out by the aforementioned practitioner. I confirm that potential complications, e.g. infection and swelling, for the procedure undertaken, and aftercare instructions have been explained to me. I confirm that the above information provided by me for this consent form is correct to the best of my knowledge, that am over the age of consent for this procedure (i.e. 18 years old for tattoos) and that I am not currently under the influence of alcohol or drugs.
Signature of Client

Clear
Date

MonthDayYear
Date
Signature of artist

Clear
Date

MonthDayYear
Date
Should be Empty:

FOR CLIENT'S INFORMATION