Fine Line Tattoo Consent Form ($75- TBD)
Fine line Tattoo is a subtle and delicate style of tattoo
Client Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Please check any and all conditions that apply to you as listed below:
*
Diabetes
Hemophilia
Heart Condition
Herpes at the site
Epilepsy
Scarring/Keloiding
Eczema/Psoriasis
Blood Thinners
T.B.
Pregnant/Nursing
Skin Condidtions
Hepatitis B/C
Allergic Reaction to Latex or Antibiotics
Blood pathogens risks, including but not limited to AIDS and HIV
History of medication use or are using medication (including being prescribed antibiotics prior to dental or surgical procedures)
NONE
Terms and Condidtions
I certify that I am at least 18 years of age
Yes
I understand that said tattoo is permanent and administered by penetrating the skin with pigment
Yes
I understand that there is a chance I might feel light-headed and/or dizzy during or after being tattooed
Yes
I understand that there is possibility of an allergic reaction
Yes
I understand that there is possibility of an infection
Yes
I understand that overtime colors and clarity of tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin
Yes
I understand that the FDA has not approved of any inks, dyes, or pigments and that health effects are unknown
Yes
I will agree to follow aftercare instructions pertaining to the body art procedure
Yes
I give Secret Ink consent to use photos for marketing purposes
Yes
Please give description of desired tattoo
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Client Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Adriana Magana | 650-445-9672 | 45 s Claremont St San Mateo, Ca 94401
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