• Tattoo Consent Form

    Dark Moth Tattoo / Wiki.Glaz_Tattoos
  • Client Information

  • Birth Date*
     - -
    2 digit day, 2 digit month, 4 digit year
  •  -
  • Date of the Appointment *
     - -
    2 digit day, 2 digit month, 4 digit year
  • Pre-Procedure Questionnaire

    Please let your tattoo artist know if you have any conditions.
  • Are you under the influence of drugs or alcohol?*
  • Are you pregnant or nursing?*
  • Do you have a transmittable disease? (Hepatitis B or C, HIV or others)*
  • Do you have any skin conditions?*
  • Do you have any other conditions?*
  • Acknowledgment/Agreement

    Please read
  • -I understand that this procedure is a permanent change to my skin and body.


    -I acknowledge that the tattoo artist does not offer refund.


    -I agree that the tattoo artist does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.                                                  

    - My Tattoo artist has been informed if I have: Cardiovascular Disease, Epilepsy, Blood-related disease, Diabetes, immunosuppression, high/low blood pressure, haemophilia or other nconditions.

    -I understand that I need to take care of the tattoo by following the instructions given to me by the Tattoo Shop/Tatto Artist.


    -I understand that as in other procedures, an infection is possible, especially if I don't follow the instructions given to me in regards of taking good care of my tattoo.

    - I understand that if I have any other process in the area of the tattoo such as medical procedures, surgeries laser or others and this deforms or changes the tattoo, the Tattoo Artist or the Tattoo Shop is will not be  held responsible. 

    -I understand that variations of colours may exist between designs and the tattoos, colour on skin may look different depending on skin types and tones. And as well I understand that imperfections may occur such as blow out.


    - I understand that this is a permanent change to my body, I agree to the size, placement and checked if dates/names etc on the design are correct.

    - I understand that pictures of the tattoo might be taken and the Tattoo Artist can post it online, use it in portfolios or other commercial uses might be given. 


    -I will hold harmless the Tattoo Shop and the Tattoo Artist against any and all claims, expenses, damages, and liabilities.

    - I am over 18 (eighteen) years  old. 

  • Signed Date*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Should be Empty: