PINK PANTHER TATTOO CONSENT AND RELEASE FORM

TATTOO CONSENT AND RELEASE FORM
I,
Name*

First NameLast Name
hereby give consent to my tattoo artist
Name of tattoo artist
at PINK PANTHER TATTOO to perform a tattoo
Description of Tattoo*
and in consideration of doing so, I hereby release the tattooer and PINK PANTHER TATTOO from all manner of liabilities, claims, actions, and demands in law, or in equity, which I or my heirs might now or hereafter by reason of complying with my request of tattoo.

I fully understand that any artist of PINK PANTHER TATTOO when performing a tattoo does not act in the capacity as a medical professional. The suggestions made by an artist or agent of PINK PANTHER TATTOO are just suggestions. They are not to be construed as, or substituted for advice from a medical professional. I understand that the tattoo will be performed using appropriate techniques, instruments, and pigments. I also understand that infections can occur due to lack of proper hygiene and/or pigment sensitivities. To ensure proper healing of my tattoo, I agree to follow the written and verbal aftercare instructions that will be provided, until healing is complete. I understand that a tattoo may take several weeks to heal properly.

I understand that I am making a permanent change to my body, and no claims about the possibility of reversing these changes have been made or implied by PINK PANTHER TATTOO or any of its artists or agents.
PLEASE ANSWER THE FOLLOWING QUESTIONS:
Has a physician told you that you have hepatitis?*
Have you been jaundice (yellowing of the skin or eyes) in the previous 10 days?*
Are you prone to fainting?*
Do you have diabetes?*
Do you have difficulty/stopping bleeding?*
Do you take a blood thinner?*
Do you have heart related problems?*
Do you have high blood pressure?*
Do you have any known allergies?*
If you have any known allergies, please list below
Have you consumed any alcoholic beverages within the last 8 hours?*
Have you consumed any food within the last 2 hours?*
Have you consumed any anticoagulants (aspirin, ibuprofen, etc.) in the last 24 hours?*
Are you pregnant?*
Do you have any other conditions that might affect the healing of this tattoo?*
If yes, please describe below
I CERTIFY THAT I AM OVER 18 YEARS OF AGE
I HAVE READ THIS RELEASE FORM AND CONFIRM THAT ALL OF THE INFORMATION I HAVE GIVEN IS CORRECT. I UNDERSTAND THAT THIS IS A RELEASE FORM AND I AGREE TO BE LEGALLY BOUND BY IT.
DATE OF BIRTH*

MonthDayYear
Date
YOUR NAME*
TELEPHONE*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMAIL*
example@example.com
Please sign, date, and upload photos of your ID (front & back)
YOUR NAME*
Signature

Clear
TODAY'S DATE*

MonthDayYear
Date
Photo ID (Front)*

Cancelof
Photo ID (Back)*

Cancelof
Should be Empty:

TATTOO CONSENT AND RELEASE FORM

PLEASE ANSWER THE FOLLOWING QUESTIONS:

Please sign, date, and upload photos of your ID (front & back)