Tattoo Consent Form

Tattoo Consent Form

Ashley Antolin Tattoos and Art
Client Information
Name

First NameLast Name
Pronouns EXAMPLE: They/Them, She/her, He/Him
Current legal name if different from above

First NameLast Name
Age
**Must be 18 years or older to legally get tattooed**
Birth Date

MonthDayYear
Date
Date of Tattoo Appointment:MM-DD-YYYY*
Is this an on going multiple session project? Yes/No*
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
Are you under the influence of drugs or alcohol?
Are you pregnant or nursing?
Do you have a communicable disease?
Do you have any skin conditions?
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Please share any relevant medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
Signed Date

MonthDayYear
Date
Client Signature
Should be Empty: