Gypsy Stables - Tattoo consent form

Tattoo consent form

Please fill in all sections
I First Name* hereby declare that I give * full consent to tattoo me and that all the information given is true to my knowledge.
Please SELECT to indicate if you suffer from any of the following
Any heart condition
Seizures
Haemophilia
Any heart condition
Compound immune system eg HIV/Hepatitis
High blood pressure
Any skin conditions eg Psoriasis
Prone to fainting/dizziness
Taking any blood thinning medications eg aspirin/warfarin
Please SELECT to indicate your answer
I am pregnant/ breastfeeding*

YesNo
I am under the influence of alcohol or drugs*

YesNo
I have requested this tattoo of my own free will*

YesNo
I am over the age of 18 years*

YesNo
Please SELECT to indicate your answer
I understand that a tattoo is a permanent mark for life and that no form of anaesthetic will be used in this procedure. I understand that every care will be taken to ensure that the tattoo procedure is performed in a hygienic way including the use of pre-sterilised single use needles. I understand that a new tattoo is susceptible to infection until healed and that care of the tattoo once I leave the studio is my esponsibility. I will follow the aftercare explained and given to me in writing. I understand associated risks include; septicaemia, scarring, allergic reactions and localised swelling/trauma. I also understand that it is my responsibility to check the design prior to it being tattooed and ensure that I am satisfied with the design andthat any lettering is the correct spelling before we proceed with the tattoo.*

YesNo
Location of the tattoo (where on your body) .
Description of tattoo: (describe the tattoo in a few words) .
Name*

First NameLast Name
Date of birth*

MonthDayYear
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
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Yes, subscribe me to this newsletter.No
Your signature*

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Tattooer Signature - Please let the tattooer review the information and sign before submiting the form*

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Tattoo consent form

Please SELECT to indicate if you suffer from any of the following

Please SELECT to indicate your answer

Please SELECT to indicate your answer