TATTOO CONSENT FORM

TATTOO CONSENT FORM

Tattoos by Nicci
This form serves as an agreement between Tattoos by Nicci (the Tattoo Shop) and the client, confirming that full consent and clear communication have been provided to ensure a safe, legal, and successful tattoo session.
CLIENT INFORMATION
NAME*

First NameLast Name
AGE*
BIRTH DATE*

MonthDayYear
Date
Please upload a picture of your driver's license, passport, state issued ID, or valid government identification*

Cancelof
PHONE NUMBER*
Format: (000) 000-0000.
EMAIL*
example@example.com
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
PRE-PROCEDURE QUESTIONNAIRE
I confirm that I am 18 years of age or older.*
Have you consumed alcohol or drugs in the past 24 hours?*

YesNo
Have you eaten within two hours of this procedure?*

YesNo
Are you taking any medications, especially blood thinners (including aspirin or ibuprofen) or anticoagulants?*

YesNo
If yes, please list:*
Do you have any of the following conditions? (Check all that apply)*

DiabetesHemophilia or other bleeding disordersHeart conditions or history of endocarditisEpilepsy, seizures, fainting, or narcolepsySkin diseases, lesions, or allergies (e.g. eczema, psoriasis)Allergies to pigments, latex, metals, dyes, or antisepticsHIV or Hepatitis B/CPregnant, Could Be Pregnant or Nursing
For your safety, please inform me of any medical conditions or history not listed above that may affect the body art process: *
Click here for Tattoo After-Care instructions and information.
*

I confirm that I have received and reviewed the Tattoo Shop aftercare instructions.
INFORMED CONSENT & ACKNOWLEDGEMENT
*

I acknowledge that if I have any health or medical concerns, it is my responsibility to consult with a physician before undergoing a body art procedure.
*

I agree to notify the artist if I am feeling unwell during or after the tattoo procedure.
*

I understand that this procedure creates a permanent change to my skin and body, and that removal would require a surgical process such as laser treatment, which may result in scarring and be costly. I acknowledge and understand tattoo inks aren't FDA approved and health effects are unknown.
*

I give permission for my tattoo to be photographed and used in the Tattoo Shop’s portfolio, as well as for promotional purposes on social media or other online platforms.
*

I acknowledge that Tattoo Shop does not offer refunds.
*

I acknowledge that the Tattoo Shop cannot determine whether I may have an allergic reaction to any of the products, materials, or ingredients used during the tattoo process.
*

I understand that I am responsible for caring for my tattoo by following the aftercare instructions provided by the Tattoo Shop, and that these instructions are not a substitute for professional medical advice. I understand that not following the aftercare instructions provided to me may result in infection or complications or may impact the appearance of the tattoo. I acknowledge that I am solely responsible for the care and healing of my tattoo once the body art has been completed.
WAIVER OF LIABILITY AND RELEASE
*

The client hereby releases Tattoos by Nicci, its artists, employees, and affiliates from any and all liability, claims, or causes of action arising from or related to the tattoo procedure and any subsequent complications. The client acknowledges that touch-ups required as a result of their own negligence will be performed at their own expense. By signing, the client provides informed consent to receive the tattoo and fully waives the right to pursue legal action against Tattoos by Nicci or its representatives.
*

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

I understand and agree that by signing the Tattoo Consent Form through Tattoos By Nicci, my electronic signature holds the same legal weight as a handwritten one, and I consent to be bound by this agreement.
CLIENT SIGNATURE*

First NameLast Name
SIGNED DATE*

MonthDayYear
Date
Should be Empty:

TATTOO CONSENT FORM

CLIENT INFORMATION

PRE-PROCEDURE QUESTIONNAIRE

INFORMED CONSENT & ACKNOWLEDGEMENT

WAIVER OF LIABILITY AND RELEASE