Consent Form
Full Name (must match ID)
*
Preferred name
Prefered pronouns
Age
*
Date of Birth
*
-
Day
-
Month
Year
Date
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Artist Name
Chosen flash piece (a description is fine)
Pre-Procedure Questionnaire
Are you pregnant or nursing?
*
Yes
No
Do you have a communicable disease
*
Yes
No
Communicable disease' (e.g. etc.Tuberculosis. Coronavirus infections. Hepatitis. Measles. HIV/AIDS.)
Do you have any skin conditions?
*
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.
Have you ever had an adverse reaction to adhesive plasters or bandaids?
*
Yes
No
Please tell us about your medical history (e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood related disease etc.)
Acknowledgment and Waive
*
I understand that this procedure is a permanent change to my skin and body
*
I allow my tattoo to be photographed and for those photos to be used on my artist, high hopes and loosefest's social media accounts and websites.
*
I acknowledge that high hopes, loosefest and my artist does not offer refunds
*
I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that
*
I understand that I need to take care of the tattoo by following the instructions given to me by my artist
*
I understand that by going ahead with treatment, I confirm that I am of sound mind and that all information provided is correct and I am going ahead at my own discretion.
*
I understand that I might get an infection if I don't follow the instructions given to me
*
I indemnify and hold harmless High Hopes, Loosefest and my artist against any claims, expenses, damages, and liabilities
*
I confirm that the information I provided in this document is accurate and true.
Photo of your photo ID
*
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