Tattoo Consent Form

TATTOO CONSENT & RELEASE FORM
Client Information
Name*

First NameLast Name
Tattoo Location*
Tattoo Description*
Birth Date*

MonthDayYear
Date
Age*
Phone Number*
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?*

YesNo
Are you under the influence of drugs or alcohol?*

YesNo
Have you ingested any medication that can inhibit the procedure or ability to heal the skin?*

YesNo
Are you pregnant or nursing?*

YesNo
Do you have any allergies or reactions to dyes, pigments, iodine or bandage adhesive?*

YesNo
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 :
I understand that this procedure is a permanent change to my skin and body. I am of a sound mind when making the decision to have a tattoo done at this time.
I allow my tattoo to be photographed and showcased with the intension of use for the artists portfolio, social media, and all future forms of promotion.
I understand that I as a client commission the artists time and the right to wear their design when purchasing the tattoo. The design itself remains the artists intellectual property.
I acknowledge that the artist does not offer refunds on any transactions.
I agree that the artist does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo. I will seek medical attention if any reactions occur.
I understand that my tattoos pigment and design may vary slightly as the tattoo naturally fades and/or ages over time.
I understand that I must take care of the tattoo by following the instructions given to me by the artist. It is my responsibility to read and follow the aftercare instructions given. I agree that any touch-up work needed due to my own negligence will be done at my own expense.
I understand the risk of infection, injury, and/or any other complications that can come with the tattoo procedure. I agree and waive the atist from all liability. The artist is not responsible for any unexpected outcomes including but not limited to scarring, septicaemia, infection, reactions etc.
I acknowledge that I have seen the artwork and/or stencil when placed on my body and agree that all spelling is correct and this is the artwork I have requested. I have asked any and all questions that come to mind about my design before the procedure and all have been answered to my total satisfaction.
I agree to reimburse the Artist for any attorneys, fees and costs incurred in any legal action I bring against the Artist or location I was tattooed in which the Artist or location of the procedures is the prevailing party.
I confirm that the information I provided in this document is accurate and true.
Upload Valid Photo ID*

Drivers License or Passport
Cancelof
Signed Date*

MonthDayYear
Date
Client Signature*

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TATTOO CONSENT & RELEASE FORM

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver