Tattoo Consent Form
PC.TATTS
Client Information
Full Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
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
By clicking the box below, I agree:
I am at least 18 years of age
*
Yes
No
I have eaten in the last two hours.
*
Yes
No
Are you under the influence of drugs or alcolhol?
*
Yes
No
Do you have any known allergies or adverse reactions to latex, iodine, pigments, dyes, disinfectants, soaps, metals, or other such product.
*
Yes
No
Are you pregnant or breast-feeding.
*
Yes
No
I understand that reaction to the pigments is still possible, even after the tattoo has healed
*
Yes
No
I understand that there may be side effects from this procedure, including swelling, bruising.
*
Yes
No
Do you have any conditions that compromise your immune system.
*
Yes
No
I have never suffered from any communicable diseases that could be transferred to another person during the procedure.
*
Yes
No
I do not suffer from hemophilia, epilepsy, narcolepsy, dizziness, fainting, or any form of seizure causing condition that could interfere with the procedure
*
Agreed
Not Agreed
I understand that every care has been taken to ensure that this procedure has been carried out in a hygienic manner, and the aftercare of the tattoo is my sole responsibility
*
Agree
Not Agree
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
I give my consent to allow PC TATTS, the use of photography which may include myself & or parts of my body for marketing and social media purposes
*
Yes
No
Acknowledgment and Waiver
*
I acknowledge that both written and verbal instructions regarding risk, outcome, and aftercare were given to me.
*
I understand that this procedure is a permanent change to my skin and body.
*
I acknowledge that PC TATTS does not offer refunds.
*
I agree and understand 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 PC TATTS
*
I understand that I might get an infection and that it may fade if I don't follow the instructions given to me in regards of taking care of my tattoo.
*
I indemnify and hold harmless PC TATTS 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
Upload Valid Photo ID (Must be over 18 years of age)
*
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Client Signature
*
Submit
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