Tattoo Consent Form
Please answer all questions below.
Client Information
Please fill out the information below to the best of your knowledge
Full Name
*
First Name
Last Name
Tattoo Description
*
Please describe your tattoo.
Price
*
Please include any deposits for the total price
Payment Method
*
Cash
Card or Applepay
Gift Certificate
Combination of Payment Methods
Who is your artist?
*
Noah
Bash
Staci
Health Questionnaire
Please select all that apply to you
Do you have any allergies such as:
*
Soaps
Latex
Alcohol
Cosmetics
Adhesives
Petroleum
Lanolin Oil
None
Other
Diseases:
*
Hepatitis
HIV/AIDS
Staph
Auto-Immune Disorder
Infections
None
Other
Overall Health
*
Heart Disease
High Blood Pressure
Diabetes
Currently Pregnant or Breastfeeding
Prone to Faintness
Skin Disease/Rash
Epilepsy
Hemophilia
Prone to Scarring/Keloids
Psoriasis
Blood Thinners
Eczema
None
Other
Acknowledgment and Waiver
By completing and signing this form, I acknowledge that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo from Moo Tattoo, and that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth, and I agree as follows:
I have truthfully represented to Moo Tattoo that I am over the age of eighteen (18).
*
I agree
I acknowledge that it is not reasonably possible for the representatives and employees of Moo Tattoo to determine whether I might have an allergic reaction to the dyes, pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.
*
I agree
I acknowledge that I have advised my tattoo artist of any condition that might affect the healing of this tattoo. I do not have medical or skin conditions such as but not limited to: acne, scarring (keloid), aczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer.
*
I agree
I am not pregnant or nursing.
*
I agree
I am not under the influence of alcohol or drugs.
*
I agree
I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. This includes sun and ultraviolet frequency damage.
*
I agree
I acknowledge that if my tattoo is a symbol, or something written in a language other than English, that Moo Tattoo is not responsible for what it may or may not mean.
*
I agree
I acknowledge the decision for obtaining my tattoo is my own free will and choice. I consent to the location of the tattoo and the performance of the tattoo procedure.
*
I agree
I agree that I have not been in contact of Covid-19 and show no signs of being sick.
*
I agree
Client Signature
*
Submit-Please only press once
Moo Tattoo
MOOTATTOO.COM INSTAGRAM @MOOTATTOOPHILLY 513 South Street 2ND Floor Philadelphia, PA
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AM/PM Option
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