Sui.Inks Tattoo Consent Form

Tattoo Consent Form
Client Information
Name*

First NameLast Name
Age*
Birth Date '*

MonthDayYear
Date
Phone Number*
Email I*
example@example.com
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?*

YesNo
Are you pregnant or nursing?*

YesNo
Do you as have an auto-immune disease or any other medical conditions that may impact the healing of your tattoo?*

YesNo
Do you have a communicable disease?*

YesNo
Do you havre any skin conditions?*

YesNo
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)*
If yes, please identify the condition.
Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, ' Epilepsy, Blood-related disease etc.)*
If yes, please identify the condition.
Acknowledgment and Waiver
I acknowledge by signing this agreement that I have been given the full opportunity yo ask any and all questions from Sui Young, herein to be referred to as the "Artist" at Northside Tattoo Studio Ltd., herein to be referred to as the "tattoo shop". I acknowledge that all of my questions have been answered to my full satisfaction.
I specifically acknowledge that I have been advised of the facts and matters set forth below:*

I understand that this procedure is a permanent change to my skin and body, and no representations have been made to me as to the ability to later change or remove my tattoo.To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo.If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medication which thins the blood, I have advised the Artist. I am not pregnant, nursing, or under the influence of alcohol or drugs.I do not have medical or skin conditions such as but not limited to: acne, scarring, keloids, eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattooI 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 at my own expense.I realize that variations in color and design between any tattoo as selected by me and as ultimately applied to the body. I understand that healed color may appear different depending on the amount of melanin in my skin.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.I allow my tattoo to be photographed and be used for the Tattoo Shop and the Artist’s portfolio showcased.I acknowledge I am over the age of 18 (eighteen) and that I have truthfully represented to my tattooer/Artist that the obtaining of a tattoo, and this tattoo is my choice alone. I consent to the application of the tattoo.I acknowledge that the the artist and Tattoo Shop does not offer refunds.I indemnify and hold harmless the the artist and Tattoo Shop against any claims, expenses, damages, and liabilities.I confirm that the information I provided in thisdocument is accurate and true.
Signed Date

MonthDayYear
Date
Please upload a photo of your government issued ID*

Cancelof
Client Signature*
Should be Empty:

Tattoo Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver