Ally- Wild Rose Tattoo

Wild Rose Tattoo

TATTOO CONSENT FORM
Client Information

For a service with Ally Wirfs, BAP-TA-10229402
This is an intake form before a service, *not* a booking inquiry form.
Please check here to say you understand that this is a health screening form for the day of a scheduled tattoo, NOT a booking inquiry. Booking information is on our website!*

I understand .
Full Name*

First NameLast Name
Pronouns
Age*
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Would you like to receive emails from Wild Rose about news and events?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-tattoo Questionnaire
Are you under the influence of drugs or alcohol? (If you mark yes to either of these, we cannot tattoo you.)*

YesNo
Are you pregnant or nursing? (If you mark yes to either of these, we cannot tattoo you.)*

YesNo
Do you have any symptoms of cold or illness such as cough, fever, congestion, shortness of breath, gastric upsets, etc? If yes, by filling this form I agree to also VERBALLY tell my artist about such conditions.*
If yes, please identify the condition.
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.) If yes, by filling this form I agree to also VERBALLY tell my artist about such conditions.*
If yes, please identify the condition.
Medications that may effect the tattoo or healing (e.g. Blood thinners, acne medications, antibiotics, anti-rejection drugs, etc.) If yes, by filling this form I agree to also VERBALLY tell my artist and have cleared it with my doctor that I am safe and able to be tattooed.*
If yes, please identify the condition.
Medical History (e.g. Auto Immune Disorders, Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.) If yes, by filling this form I agree to also VERBALLY tell my artist about such conditions and have cleared it with my doctor that I am safe and able to be tattooed.*
If no, type "no". If yes, please identify the condition.
Acknowledgment and Waiver
*

I agree to not bring any guests without prior approval from my artist.
*

I understand that this procedure is a permanent change to my skin and body.
*

I agree to have eaten a protein rich meal no longer than two hours before my appt.
*

I allow my tattoo to be photographed and shared on Ally and Wild Rose Tattoo's social media accounts.
*

I acknowledge that Wild Rose Tattoo does not offer refunds.
*

I agree that Ally and Wild Rose Tattoo do 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 I need to take care of the tattoo by following the instructions given to me by my artist.
*

I understand that I might get an infection if I don't follow the instructions given to me in regards of taking care of my tattoo.
*

I understand that it is my responsibility to make sure any script in my tattoo is spelled correctly.
*

I understand that the use of numbing creams or sprays is at my own risk and that Ally and Wild Rose Tattoo are not liable for any complications with or from their use.
*

I indemnify and hold harmless Ally, Wild Rose Tattoo and the artists therein against any claims, expenses, damages, and liabilities.
Front of current, government issued ID. (Driver's License/passport)*

Browse Files

Cancelof
*

I confirm that the information I provided in this document is accurate and true.
Signed Date*

MonthDayYear
Date
Client Signature*
Should be Empty:

Wild Rose Tattoo

Client Information

This is an intake form before a service, *not* a booking inquiry form.

Pre-tattoo Questionnaire

Acknowledgment and Waiver

This is an intake form before a service, not a booking inquiry form.