BROWTOURAGE - Tattoo - Consent Form

  • Confidential Medical Profile and Tattoo Release Form

  • Date Of Birth*
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  • To avoid unforeseen complications, please answer the following questions:

  • Are you 18 years old or older?*
  • Are you pregnant or nursing?*
  • Are you allergic to any metal?*
  • Have you had any aspirin or blood thinners in the past week?*
  • Have you ever had any Tattoo procedures before?*
  • Have you had any mood altering drugs within the last 8 hours?*
  • Are you on any immuno-suppressive medications such as anti-infiammatories or steroids?*
  • Do you have a history of cold sores, herpes, or fever blisters?*
  • Are you allergic to topical antibiotic preparations or de-sensitizers?*
  • Are you sensitive/allergic to latex?*
  • Is there any history of skin diseases or remarkable skin sensitivities?*
  • Are you ready to get your Tattoo today?*
  • Are you currently undergoing Radiation or Chemotherapy?*
  • Are you required to take Antibiotics during Dental or Invasive Medical procedures?*
  • Previous problems with tattoos or has your physician advised you not to have a tattoos at this time?*
  • Rows
  • Read and Check All The Boxes*

  • By signing below, I acknowledge, understand and agree that:

    • the staff at BrowTourage do not practice medicine, does not accept health insurance, and have made no representation to the contrary;
    • the information provided on this form is accurate and complete to the best of my knowledge, and that BrowTourage is not responsible for complications or problems arising from any incorrect or omitted information;
    • some individuals will have complications related to Tattooing application. These complications are usually mild and last only a few days. However, extreme complications are always a possibility. I accept these risks and agree to hold BrowTourage and its employees and contractors harmless for same;
    • the staff at BrowTourage will use the information provided above to assess my suitability for the tattooing services.
    • I have read and understand the contents of each statement above.
    • I acknowledge that this is a contract and that I have received no warranties or guarantees with respect to the benefits to be realized from, or consequences of, the aforementioned procedure(s).
    • I further acknowledge that at the time of signing this consent I am of sound mind and capable of making independent decisions for myself.
    • I hereby release and forever discharge and hold harmless BrowTourage and its owners, managers, employees and affiliates from any and all claims, damages or legal actions arising from or connected in any way with my tattoo, or the procedure and conduct used in my performing my tattoo, to the fullest extent allowed by the law.
  • Date*
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