Name
*
First Name
Last Name
Preferred Pronouns
Preferred Name (If not Legal Name)
What type of appointment would you prefer today? *note: if I go quiet during our time I am not upset I am lost in concentration. :)*
Music + chit chat
Music only, limited chatting
Streaming (I have everything except Netflix)
Headphones or silent/Meditation
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Are you at least 18 years old or above?
*
Yes
No
Age:
*
Which tattoo artist?
*
Please Select
Morgan Patterson
How did you hear about us?
*
Instagram
TikTok
Referral
Other
If other, please elaborate.
If referred, by whom?
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Primary Care Physician Name
*
Please do not leave blank. (If not applicable, please enter "Watson Clinic")
Primary Care Phone Number
*
Please enter a valid phone number.* If using Watson Clinic* (863) 680-7271.
Primary Care Address
*
Street Address *If using Watson clinic* (1600 Lakeland Hills Blvd)
Street Address Line 2
City
State / Province
Postal / Zip Code
Brief Description of your Tattoo
*
Tattoo Location on Body
*
Please take a photo of the front of a *Government Issued ID and upload here.
*
Browse Files
Drag and drop files here
Choose a file
*Driver's License, Passport, or State Issued ID
Cancel
of
I understand that all sales transactions are final and non-refundable.
*
Yes
No
Have you eaten today?
*
Yes
No
Would you like to list any prescription medications you are currently taking in case of a medical emergency?
Put N/A if not applicable.
Do you need to consult with a Doctor before getting tattooed today?
Yes
No
RISKS/WAIVER - I acknowledge that I have been fully informed of the inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risks, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks. I agree TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from my tattoo, whether caused by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise.
*
Yes, I wish to proceed.
No, I do not wish to proceed.
HEALING - The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it's healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.
*
Yes, I wish to proceed.
No, I do not wish to proceed.
INFLUENCE - I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion. Do you affirm this statement?
*
Yes, I wish to proceed.
No, I do not wish to proceed.
Do you have any bloodborne or transmittable diseases that could impair your ability to be tattooed today.
*
Yes
No
Do you have diabetes?
*
Yes
No
Do you have epilepsy, hemophilia, or a heart condition?
*
Yes
No
Are you currently pregnant or nursing?
*
Yes
No
LEGAL ACTION - I agree to reimburse each of the Artists and the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of Florida shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement. Do you affirm this statement?
*
Yes, I wish to proceed.
No, I do not wish to proceed.
QUESTIONS & UNDERSTANDING - I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.
*
Yes, I wish to proceed.
No, I do not wish to proceed.
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.
*
Yes, I wish to proceed.
No, I do not wish to proceed.
PHOTOGRAPHY - I release all rights to any photographs, videos or audios recorded of me or any part of my likeness and the tattoo or body piercing and give consent in advance to their reproduction in print or electronic form. (If you do not tick this provision, please advise your Artist).
*
Yes, I wish to proceed.
No, please do not take any photos.
I AGREE AND ACKNOWLEDGE THAT I HAVE ANSWERED THESE QUESTIONS TRUTHFULLY AND TO THE BEST OF MY ABILITY. BY TYPING MY NAME BELOW, I AM USING THIS AS MY ELECTRONIC SIGNATURE AND SEALING THIS AGREEMENT. MY ELECTRONIC SIGNATURE:
*
SUBMIT
SUBMIT
Should be Empty: