Tattoo Consent Form
Client Information
Full Name
*
First Name
Last Name
Are you 18+?
*
Please Select
Yes
No
Returning Client
Have you chosen your desired tattoo?
*
Please Select
Yes
No
Desired Tattoo Placement
*
If you have a referance photo, you may upload here:
Browse Files
Cancel
of
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
-
+44
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Procedure Questionnaire
Do you understand being under the influence of either drugs or alcohol is both prohibited and not recommended?
*
Yes
No
Pregnancy or Nursing?
*
Yes
No
Do you have a communicable disease/virus (e.g.Hep B, Hep C ,Hep D, HIV )? This information is private and only shared with your artist, Amara Nicole.
*
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Medical History (e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Are you taking any prescribed medication regularly (especially any anticoagulant such as warfarin, aspirin immuno-suppressants such as steroids
If yes please give details
Any allergic responses to metals/Plasters or creams/latex or anything else we should know
If yes please give details
Any known/previous reaction to dye pigments?
If yes please give details
Acknowledgment and Waiver
*
I understand that this procedure is a permanent alteration to my skin and body.
*
I will allow my tattoo to be photographed and used for social media, ads, content, etc. across Inked by Journey platforms.
*
I acknowledge that once service is rendered, Inked by Journey does not offer any refunds once a price has been agreed upon between artist and client. (Deposits are always non-refundable)
*
I understand that Inked by Journey does not have any way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo, and trust the artist is using the highest quality to ensure the best results.
*
I understand that I will need to follow proper aftercare instructions given to me by my artist, Amara Nicole, to maintain results.
*
I understand that an infection can/may occur if the proper aftercare instructions given are not followed and that Inked by Journey is not deemed responsible.
*
I understand that the tattooing process may result in certain risks and side effects, including but not limited to: Bruising, Swelling, Infection, Allergic Reaction, Scarring. I understand that these risks have been explained to me, and that they are associated with the tattoo procedure. Reactions may vary and I accept the possibility of these risks.
*
I confirm that the information I provided in this document are accurate and true.
Have you scheduled & paid your deposit on our booking site?
*
Yes
No
Client Signature
*
Submit
Submit
Should be Empty: