Tattoo Consent Form
Client Information
Name
*
First Name
Last Name
Age*
*Must be 18 or over.
Birth Date
-
Month
-
Day
Year
Date
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
*
Yes
No
FEMALE ONLY: Are you pregnant or nursing?
*
Yes
No
Do you have a communicable disease?
*
Yes
No
Do you have any skin conditions?
*
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
*
If yes, please identify the condition.
Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
*
If yes, please identify the condition.
Acknowledgment and Waiver
*
I understand that this procedure is a permanent change to my skin and body.
*
I allow my tattoo to be photographed and be used for Tattoo Shop portfolio showcased.
*
I acknowledge that the Tattoo Shop does not offer refund.
*
I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.
*
I understand that I need to take care of the tattoo by following the instructions given to me by the Tattoo Shop.
*
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking food care of my tattoo.
*
I indemnify and hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities.
*
I confirm that the information I provided in this document is accurate and true.
Signed Date
*
-
Month
-
Day
Year
Date
Client Signature
*
Submit
Submit
Should be Empty: