You can always press Enter⏎ to continue
Client Waiver
Please complete our Client Waiver 24 hours prior to your visit.
START
1
What is your Full Name?
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
What is your Instagram handle?
If you add your Instagram handle here, we'll follow your account and we can stay connected through the platform.
Previous
Next
Submit
Press
Enter
3
How did you find out about Taproot?
Friend or Family
Google
Yelp
Facebook
Instagram
Walked By
Other
TikTok
Previous
Next
Submit
Press
Enter
4
Who may we thank for referring you?
Previous
Next
Submit
Press
Enter
5
Date of Birth
/
Date
Month
Day
Year
Previous
Next
Submit
Press
Enter
6
What is your Date of Birth?
*
This field is required.
Previous
Next
Submit
Press
Enter
7
Driver's License, ID or Passport number
*
This field is required.
Previous
Next
Submit
Press
Enter
8
Identification Expiration Date
*
This field is required.
mm/dd/yyyy
Previous
Next
Submit
Press
Enter
9
Identification Expiration Date
/
Date
Month
Day
Year
Previous
Next
Submit
Press
Enter
10
Upload an image of your identification (Photo ID)
*
This field is required.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
of
Previous
Next
Submit
Press
Enter
11
What is your current physical mailing address?
*
This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Previous
Next
Submit
Press
Enter
12
What is your cell phone number?
*
This field is required.
Area Code
Phone Number
Previous
Next
Submit
Press
Enter
13
What is your preferred email address?
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
14
Tattoo Description & Placement
*
This field is required.
Tattoo Description
Tattoo Placement
Previous
Next
Submit
Press
Enter
15
I certify that I am not under the influence of alcohol or any other intoxicating substances
*
This field is required.
I certify I am not under the influence
Previous
Next
Submit
Press
Enter
16
I certify that I am 18 years of age or older. I will provide identification to verify my age. I understand that I am liable for criminal prosecution if I misrepresent my age with false information or documentation.
*
This field is required.
I certify I am 18 years of age or older
Previous
Next
Submit
Press
Enter
17
Do you have allergies or sensitivities to the following?
*
This field is required.
Latex
Medicines
Topical solutions such as soap, alcohol, over-the-counter disinfectants
Adhesives
I have no known allergies or sensitivities
Previous
Next
Submit
Press
Enter
18
Please list all medications and supplements you are currently taking.
Previous
Next
Submit
Press
Enter
19
Do you have any skin conditions?
*
This field is required.
Psoriasis
Eczema
Are you currently experiencing cold sores?
Are you currently experiencing fever blisters?
Scars in the area to be tattooed
Acne in the area to be tattooed
I have no known skin conditions
Previous
Next
Submit
Press
Enter
20
Are you Hemophiliac, prone to heavy bleeding or taking blood thinner medication?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
21
Please describe.
Previous
Next
Submit
Press
Enter
22
Are you pregnant?
*
This field is required.
It is shop policy that we do not tattoo pregnant people at Taproot.
YES
NO
Previous
Next
Submit
Press
Enter
23
Are you breastfeeding?
*
This field is required.
It is legal in the State of Alabama to be tattooed while breastfeeding. It is advisable that you contact a medial professional prior to being tattooed to discuss the possible risks associated with breastfeeding after being tattooed.
YES
NO
Previous
Next
Submit
Press
Enter
24
Do you have any medical conditions?
*
This field is required.
Diabetes
High blood pressure
Low blood pressure
Anemia
I have no known medical conditions
Previous
Next
Submit
Press
Enter
25
Please describe any other medical conditions you may have.
Previous
Next
Submit
Press
Enter
26
Do you experience any of the following?
*
This field is required.
Prone to fainting
Panic attacks
Uneasiness/fainting around needles
Uneasiness/fainting around blood
Anxiety
I do not experience any of the above mentioned conditions
Previous
Next
Submit
Press
Enter
27
Please describe.
Previous
Next
Submit
Press
Enter
28
Do you use a mobility device?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
29
Please let us know if there is any assistance that might be needed during your visit.
Previous
Next
Submit
Press
Enter
30
I understand that I will be tattooed using instruments and techniques selected by Taproot Tattoo Studio. To ensure proper healing of my tattoo, I agree to follow the aftercare procedures outlined in the aftercare instructions provided to me, either verbally or physically, until healing is complete.
*
This field is required.
Please initial below.
Previous
Next
Submit
Press
Enter
31
I understand that the private contractor of Taproot Tattoo Studio are not medical professionals. Any suggestions made by a representative of Taproot Tattoo Studio will not be construed as, or substituted for, medical advice from a physician.
Please initial below.
Previous
Next
Submit
Press
Enter
32
Initials
*
This field is required.
Previous
Next
Submit
Press
Enter
33
I understand that complications, including but not limited to: scarring, loss of color/pigment, infections, allergic reactions (to ink, ointment, soaps, or instructions) and differing results of brightness/color because of skin type/tone/age are possible outcome of the tattoo healing process.
*
This field is required.
Please initial below.
Previous
Next
Submit
Press
Enter
34
Do you give permission to have your photo taken?
*
This field is required.
Photos can be used for, but not limited to the following: Digital and physical portfolios, limited advertisement and promotional materials online and physical media.
YES
NO
Previous
Next
Submit
Press
Enter
35
By my signature, I certify that I had read and understood the agreement. All of my questions have been answered to my satisfaction. I accept the risks and will not hold Taproot Tattoo Studio, its representatives or artists, responsible. I freely consent to the tattoo procedure.
*
This field is required.
Please sign below.
Clear
Previous
Next
Submit
Press
Enter
36
Please enter today's date
*
This field is required.
/
Date
Month
Day
Year
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
36
See All
Go Back
Submit
