Tattoos by Divina Procedure Waiver
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
The date of my appointment is
-
Month
-
Day
Year
Date
I understand that this is a binding contract with Indigo Studios, LLC & I have been given full opportunity to ask any and all questions about my procedure. I hereby acknowledge that I have voluntarily requested a tattoo to be applied to my body by Divina Graisy, at Indigo Studios, LLC. I understand that my procedure is permanent, I understand that the process of tattooing involves the use of needles to puncture the skin and inject ink into the dermis layer. I am aware that this process involves certain risks, including but not limited to infection, allergic reaction, scarring, and variations in color and texture.
I agree to this statement
do not have any medical conditions or communicable diseases (including but not limited to diabetes, epilepsy, hemophilia, hepatitis, HIV, AIDS, tuberculosis, COVID19). I do not have a skin condition that may interfere with the proper healing of my procedure (including but not limited to acne, scarring or keloids, eczema, psoriasis, freckles, moles, or sunburn). I am not pregnant or nursing. I have informed the agent of Indigo Studios, LLC and documented below of any exceptions to the above. I am not under the influence of drugs, alcohol, or any narcotic, including but not limited to prescription pharmaceuticals, & over the counter medications. I am aware that being under the influence can have an adverse effect on the procedure. I agree that Indigo Studios, LLC cannot determine if I will have an allergic reaction to any of the products used to complete my procedure. I attest that I have no known allergies, or if I do I have documented them on the back of this form and alerted the agent of Indigo Studios, LLC.
I agree to this statement
I am aware of the possibility of infection with my procedure. I understand that when I leave the premises of Tattoo Studio, my procedure is only half complete. For proper healing it is my responsibility to follow the aftercare procedures recommended by Indigo Studios, LLC Tattoo Studio. Indigo Studios, LLC makes no claim to the success or validity of the recommended aftercare procedures, they are simply guidelines. I agree to not hold Indigo Studios, LLC liable for any necessary touch-up work caused by my own negligence. I understand that skin color will have an effect on the final result of my tattoo. I understand that there are no refunds for this tattoo procedure. I agree to leave the premises of Indigo Studios, LLC or any other location where Indigo Studios, LLC Tattoo Studio is engaged in business promptly upon request, for any reason whatsoever, by any employee or agent of Indigo Studios, LLC.
I agree to this statement
Today's Date
-
Month
-
Day
Year
Date
Signature
ID / Driver License
*
Browse Files
Drag and drop files here
Choose a file
Upload a picture of your ID here please 😊
Cancel
of
Submit
Submit
Should be Empty: