Tattoo Event Consent Form
Client Information
Name
*
First Name
Last Name
Preferred Name
Preferred Pronouns
Age
*
Birth Date
*
-
Month
-
Day
Year
Date
Phone Number
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
*
Yes
No
FEMALE ONLY: Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
Yes
No
Do you have any skin conditions?
Yes
No
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.
Which piece are you interested in? Include placement and whether you prefer black & grey or color (only for $200 and $300 tiers)
*
.
Acknowledgment and Waiver
Photo release
*
I allow my tattoo to be photographed and be used for the artist's portfolio/social media
I would prefer not to have photos taken
*
I understand that this procedure is a permanent change to my skin and body.
*
I understand that I need to take care of the tattoo by following the instructions given to me by the artist
*
I understand that risk of infection is increased if the aftercare instructions are not followed.
*
I hold harmless the artist and studio against any claims, expenses, damages, and liabilities.
*
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 acknowledge that the deposit is non refundable.
Type a question
*
I will notify the artist at least 24hrs prior my appointment of any need to reschedule or cancel
Type a question
*
I understand that if I am more the 30 (thirty) minutes late for my scheduled appointment time my deposit may be forfeit and the artist may require me to reschedule
Type a question
*
I would prefer the full ritual experience
I would prefer NOT to participate in the ritual experience
*
I confirm that the information I provided in this document is accurate and true.
Signed Date
-
Month
-
Day
Year
Date
Client Signature
*
My Products
*
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Event Deposit (Tattoo Only)
Deposit to hold your reservation to the "Love Bites Tattoo Event" Tattoo only
$
80.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
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