LOVE STREET TATTOO CONSENT FORM
7 Love Street, Cloverdale 6105
Name of Tattoo artist
*
Please Select
Scott
Deadsoul (April)
Josh
Morganite
Emma
Jordan
Zak
Reuben
Sheri
Sophie
Guest
Dyn.goe
Banjo
Cooper
Asha
Tattoo description
*
Client Information
Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Procedure Questionnaire
Have you eaten in the last four (4) hours?
*
Yes
No
Have you had any alcoholic beverages in the last eight (8) hours?
*
Yes
No
Have you taken aspirin, ibuprofen or blood thinners in the last twenty four (24) hours?
*
Yes
No
Are you prone to heavy bleeding?
*
Yes
No
Are you prone to fainting?
*
Yes
No
Are you pregnant or breastfeeding?
*
Yes
No
Do you have high blood pressure?
*
Yes
No
Do you have a latex allergy?
*
Yes
No
Do you have any other known allergies?
If yes, please identify the condition.
Do you have any other conditions which might affect the healing of this tattoo?
If yes, please identify the condition.
Acknowledgement and Waiver
*
I fully understand that any employee or agent of this Tattoo studio when performing a tattoo does not act in the capacity as a medical professional. The suggestions made by any employee or agent of this studio are just suggestions. They are not to be constructed as, or substituted fpr advice from a medical professional.
*
I UNDERSTAND THAT I WILL BE TATTOOED USING appropriate techniques, instruments and pigments. To ensure proper healing of my tattoo, I agree to follow the written and verbal Tattoo Aftercare instructions that will be provided until healing is complete. I understand that a tattoo may take two weeks or longer to heal properly
*
I WILLINGLY SUBMIT TO THESE PROCEDURES with a full understanding of possible complications such as but not limited to infection, allergic reason or rejection of the ink. Neither the artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol that I have provided to them or chosen from the flash design sheets
*
I HAVE RECEIVED A COPY OF THE WRITTEN TATTOO AFTERCARE INSTRUCTIONS, which I have read and fully understood, and hereby assume full responsibility for aftercare and cleanliness. I understand that by having this tattoo performed I am making a permanent change to my body and no claims have been made regarding the ability to undo the changes made
*
I acknowledge that the sterilisation method used was explained to my full satisfaction. I had the opportunity to ask questions regarding this procedure. All questions were answered to my satisfaction. All equipment during the procedure was opened in front of me. I witnessed the disposal of the tattoo needle/s into regulated sharp containers. Both written and verbal Tattoo aftercare instructions were provided to me. I have read this Tattoo Consent & Release form that all the information I have given is correct. I understand that this is a release form and I agree to be legally bound by it
*
I confirm I am 18 years of age or older
Upload a photo of your ID
*
Client Signature
*
Signed Date
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: