Tattoo Consent Form
Client Information
Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Date
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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
Acknowledgment and Waiver
Type a question
I understand that this procedure is a permanent change to my skin and body.
Type a question
I allow my tattoo to be photographed and be used for Studio Elora's portfolio showcased.
Type a question
I acknowledge that Studio Elora does not offer refund.
Type a question
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.
Type a question
I understand that I need to take care of the tattoo by following the instructions given to me by Studio Elora.
Type a question
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo.
Type a question
I indemnify and hold harmless Studio Elora against any claims, expenses, damages, and liabilities.
Type a question
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: