Consent to Tattoo Procedure

Consent to Tattoo Procedure

2505 SE 11th Avenue, Suite 340 Portland, Oregon 97202
Full Name*

First NameLast Name
Nickname
If you would like us to address you by something other than your legal first name.
Pronouns*
She/Her, He/Him, They/Them, Other
Date of Appointment*

MonthDayYear
Date
Age*
Date of Birth*
Drivers License #*
Photo of Drivers License (FRONT)*

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Signature to agree to Photo ID upload. *

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Email Address*
Your Phone #*
I understand that if I move while my artist is tattooing, it could result in inconsistent linework. It is especially crucial for fineline tattoos that all movement (even small ones) be planned for when the artist is not tattooing (dipping ink, wiping, or asking your artist to pause so that you can adjust your body). Movements that can affect linework include: moving your arm to touch hair/face/mask, lifting your phone up and down, dropping your phone, talking while moving your head or arms. *
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Client Medical History; Please select each confidential question to the best of your knowledge.*

I have Diabetes, Epilepsy, or a Heart Condition?I have Hemophilia?I have a skin disease, or lesions?I have allergies to soaps or metals?I have any blood-borne diseases? (HIV, Herpes, Hepatitis, etc.)I am prone to fainting?I have NOT had food two hours prior to my appointmentI am pregnant?Are there any other conditions that would effect your healing process? List belowN/aOther
Name of your Tattoo Artist*
Are you comfortable with photos or videos being taken during your appointment by your artist or Arabelle, our shop manager to be shared on social media?*

YesNoAsk me that dayOther
Please read the following statements and sign below to acknowledge them.
1. I understand that to ensure proper healing of my tattoo, I agree to follow the written/verbal aftercare instructions given by my artist until healing is completed. And that if I do not follow the instructions, infections can occur.
  I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.
2. I understand that it is not reasonably possible for the employees of Midnight to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo procedure, and I agree to accept the risk that such reaction is possible, as well as all risks that may come from a tattoo procedure.
3. I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. I I have any infection or visible rash anywhere on my body, I have advised my tattooer.
4. I have been given the full opportunity to ask any and all questions I may have about obtaining my tattoo from my artist, and all of my questions have been answered to my full and total satisfaction.
5. I have read this release form and confirm that all the information I have given is correct and I agree to be legally bound by it. I waive and release to the fullest extent permitted by law any person at Midnight from all liability whatsoever, including but not limited to, any and all claims or causes of action that we may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either Midnight and it’s employees, or otherwise.
6. I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo.
Signature*

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Aftercare Instructions

These instructions will be verbally communicated to you at the end of your procedure, and we are happy to answer any questions regarding your tattoo healing process via e-mail.

Leave the protective wrapping on your tattoo for the next 2-3 hours. After you are home for the night, gently wash your tattoo with Gold Dial Antibacterial Soap in the shower. Let the tattoo air dry for the rest of the evening *do not wrap it again during the entire healing process*. Wear loose-fitting clothing to protect your tattoo during the healing process.

Day 2: Begin applying Unscented lotion: CETAPHIL (My #1 recommended brand), Burts Bees or Aveeno work great, NOT Aquaphor. I recommend using lotion instead of gelatin-based products because it allows the skin to breath, and also absorbs into the skin instead of resting on top of it. This prevents scabs from being too moist, and ripping off too soon which can cause ink loss, and potential scarring. Lotion 2-3 times a day for a minimum of 2 weeks, but not limited to the entire first month of healing your new tattoo. Continue to gently wash with the Dial soap until the tattoo is no longer an open wound. NO sun exposure, or exposure to bodies of water for the first month of your new tattoo (this includes bath tubs, hot tubs, hot springs, the ocean). WEAR SUN BLOCK FOR THE REST OF YOUR LIFE IF YOU WANT YOUR TATTOO TO REMAIN PRETTY. :-)

Instructions for Second Skin/Sani-Derm clear bandage: Leave the bandage on for 1-5 days (ideally 3-5 days), unless otherwise directed by your artist. When the bandage is ready to come off, do so under running water- you can use coconut oil or lotion around the edges to lift the bandage up gently, pulling away from your body. Do not rip the bandage off aggressively, as this could result in ink fall-out depending on which day you are taking the bandage off. Once the bandage is removed, disinfect with anti-bacterial soap, and start using unscented lotion twice a day for the next 3-4 weeks, following the above aftercare instructions.

Reasons to take off your bandage sooner than 3-5 days: if you notice sweat beading underneath, an excess of plasma (normal minimal tattoo leakage is okay! but anything that looks like a large pocket of fluid will warrant removal of the bandage), any tears, puncture, or lifting of the bandage that can potentially allow bacteria to enter. Allergic reactions: discomfort/redness around the edges of the bandage, in rare cases blistering, are also reasons to take the bandage off. Reach out to your tattoo artist if you have questions regarding an allergic reaction, typically this will not affect the tattoo and can be resolved by using benadryl cream.
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