Tattoo Consent Form

Tattoo Consent Form

Waiver -Deposit
Client Information

* = Required Fields
Name*

First NameLast Name
Age
Birth Date*

MonthDayYear
Date
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
A Brief Description Of Tattoo & Placement
Pre-Procedure Questionnaire
You will not be under the influence of drugs or alcohol*

I agree.
FEMALE ONLY: Are you pregnant or nursing?

YesNo
Do you have a communicable disease?*

YesNo
Do you have any skin conditions?*

YesNo
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Please tell about your medical history that could be relevant. (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
Check to certify*

I understand that this procedure is a permanent change to my skin and body.
Check to certify*

I allow my tattoo to be photographed and be used for @tattoosbyvansterdan Instagram and other social media to be showcased.I do not consent to my pictures being shared on social media.
Check to certify*

I acknowledge that the PrettyAlrightTattoos does not offer any refunds.
Check to certify*

I will eat and hydrate before coming and - if coming for a longer session will be prepared, ie: bring snacks and a beverage to ensure blood sugar levels are maintained. Fruit, trail mix, granola bars, juice, water, etc.
Check to certify*

I understand 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.
Check to certify*

I understand that I need to take care of the tattoo by following the instructions given to me by my artist.
Check to certify*

I understand that I might get an infection if I don't follow the aftercare instructions given to me by my artist.
Check to certify*

I indemnify and hold harmless the Daniel H. Wilson (PrettyAlrightTattoos) against any and all claims, expenses, damages, and liabilities.
Check to certify*

I confirm that I understand the deposit is required before booking and is non-refundable. Etransfer $50 to Vansterdan.pts@gmail.com or cash only.I understand there is a 48 hour cancellation notice and re-booking will have to be done at the time of cancellation or deposit will be forfeit.I understand that I have 6 months to be booked for application from date of deposit. Past 6 months deposit is forfeit and another deposit will be required for booking.
I have sent an etransfer deposit of $50 to vansterdan.pts@gmail.com*

Yes
Signed Date

MonthDayYear
Date
Client Signature

Clear
Should be Empty:

Tattoo Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver