Fine Line Tattoo Consent

Fine Line Tattoo Consent
Client Information
Name

First NameLast Name
Age
Birth Date

MonthDayYear
Date
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?

YesNo
Have you consumed alchol in the last 24 hours?

YesNo
If yes, how much and when.
FEMALE ONLY: Are you pregnant or nursing?

YesNo
Are you currently taking Blood Thinners?

YesNo
If yes, please list them.
Do you have any communicable diseases?

YesNo
If yes, please list them.
Do you have any skin conditions?

YesNo
Skin conditions (e.g. Rashes, Eczema, Infections, Psoriasis,Hyperpigmentation , 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 give consent to be photographed and I give Poise Beauty Bar permission to use my photographs for Social Media content as well as advertising.
I acknowledge that Poise Beauty Bar does not offer refunds for tattoo work under any circumstance.
I acknoledge that the tattoo 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 understand that it is my full responsibility to care for my tattoo as the tattoo artist has described and to use only the products instructed by the tattoo artist. If failure to do so I acknoledge that I may be at risk for infection.
I understand that tattooing comes with the risk of potential infections may become present. If the tattooed area does become infected I will contact a physician.
I indemnify and hold harmless Poise Beauty Bar and the Tattoo Artist against any claims, expenses, damages, and liabilities.
I confirm that the information I provided in this document is accurate and true.
Signed Date

MonthDayYear
Date
Client Signature
Should be Empty:

Fine Line Tattoo Consent

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver