Consent Form

Consent Form
Full Name (must match ID)*
Preferred name
Prefered pronouns
Age*
Date of Birth*

DayMonthYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Artist Name
Chosen flash piece (a description is fine)
Pre-Procedure Questionnaire
Are you pregnant or nursing?*

YesNo
Do you have a communicable disease*

YesNo
Communicable disease' (e.g. etc.Tuberculosis. Coronavirus infections. Hepatitis. Measles. HIV/AIDS.)
Do you have any skin conditions?*

YesNo
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.
Have you ever had an adverse reaction to adhesive plasters or bandaids?*

YesNo
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*

Cancelof
Signed Date

MonthDayYear
Date
Signature*
Should be Empty:

Consent Form

Pre-Procedure Questionnaire