Tattoo Consent Form
Customer Information
Name
*
First Name
Last Name
Age
*
Birth Date
*
-
Month
-
Day
Year
Date
Phone Number
Email
*
example@example.com
Pre-Procedure Questionnaire
Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
Yes
No
Do you have any skin conditions?
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, etc.)
If yes, please identify the condition.
Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
I understand that this procedure is a permanent change to my skin and body.
I allow my tattoo to be photographed/videographed
I grant permission to use photographs/videos for the purpose of promotion, publication, online, etc.
I understand that I need to take care of the tattoo by following the instructions given to me by the Tattooer.
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo.
I confirm that the information I provided in this document is accurate and true.
Signed Date
-
Month
-
Day
Year
Date
Client Signature
Submit
Submit
Should be Empty: