SINK OR SWIM TATTOO CONSENT FORM
Name
*
First Name
Last Name
Age
*
Birth Date
*
-
Month
-
Day
Year
Date
Phone Number
*
Format: (000) 000-0000.
ID NUMBER (drivers license or passport)
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Tattoo Questionnaire and Medical History
TATTOO ARTIST
GARY/SAWDUST
WILLOW
RAISA
REBECCA
Other
Have you been diagnosed with any of the following:
*
High Blood Pressure
Diabetes
Seizures/Epilepsy
Asthma
Cancer
Cardiac Disease
Psychiatric Disorder
None
Are you experiencing any of the following symptoms:
Chest Pain
Respiratory Distress
Dizziness/Light Headed
Headaches
Physical Distress/pain
Cold/Flu symptoms
List any medications you are currently taking
List any allergies you have
Are you allergic/sensitive to LATEX? If YES, please verbally inform your artist.
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.
Acknowledgment and Waiver
I understand that this procedure is a permanent change to my skin and body. I acknowledge that I have discussed all pertinent information regarding the design of my tattoo, and that I have asked any and all questions regarding this procedure and am satisfied that all concerns I have were answered fully.
I acknowledge that Sink Or Swim Tattoo does not offer refunds for any reason.
I agree that Sink Or Swim Tattoo, nor my tattoo artist, have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo. I also acknowledge that I have informed my artist of any known allergies or sensitivities that I have to Latex, or any other materials that may be used in this procedure.
I understand that I need to take care of the tattoo by following the instructions given to me by the Tattoo Shop, and as explained by my artist. I will contact the shop, or my artist if I have any questions regarding aftercare.
I understand that an infection is possible if I don't follow the aftercare instructions provided. I also understand that the artist and/or shop are not responsible for any issues or expenses that may arise as a result of my failure to follow the provided aftercare instructions.
I indemnify and hold harmless , Sink Or Swim Tattoo, as well as my tattoo artist, against any claims, expenses, damages, and liabilities.
I confirm that I have read the entirety of this form, and all information I provided in this document is accurate and true.
Signed Date
*
-
Month
-
Day
Year
Date
Client Signature
*
Opt-in for email marketing to receive shop updates and special offers.
Yes, I would like to receive emails from Sink or Swim.
Submit
Submit
Should be Empty: