Tattoo Consent Form

TATTOO CONSENT & RELEASE FORM
Client Information
Name

First NameLast Name
Tattoo Location
Tattoo Description
Birth Date

MonthDayYear
Date
Age
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Have you eaten within the last 4 hours?
Are you under the influence of drugs or alcohol?
Have you ingested any medication that can inhibit the procedure or ability to heal the skin?
Are you pregnant or nursing?
Do you have any allergies or reactions to dyes, pigments, iodine or bandage adhesive?
Do you have any skin conditions? (e.g. Rashes, Eczema, Infection, Psoriasis, Moles, etc.)
If yes, please identify the condition.
Do you have any medical conditions? (e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Do you have any communicable diseases? (e.g. Hepatitis A, Hepatitis B, HIV, AIDS etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
For and in consideration of receiving a tattoo from Name of Artist * , a licensed Tattoo Artist doing business at Address of which the procedure will take place *. I First name as on ID* Last name as on ID* agree to the following :
Upload Valid Photo ID

Drivers License or Passport
Cancelof
Signed Date

MonthDayYear
Date
Client Signature
Should be Empty:

TATTOO CONSENT & RELEASE FORM